Wiki pain vs unspecified injury

[PaigeMatthews]

I previously worked at an orthopedic practice where we attended a KZA conference and were told when a patient comes in with an injury and doctors "Dx" is pain to code to unspecified injury, so as a practice, this is what we did. Now, I'm at a new establishment and can't find any 'proof' to follow the guideline other than ' I was told at a KZA conference ' one time ... Should I be coding to pain or unspecified injury, anyone have any information backing this up?
Thanks!

 

[amyjph]

You have to use the ICD-10 guidelines and not a verbal direction from someone, even if that someone is generally a reputable source. I think this also depends on each individual note and what is documented in the record. This is always a tough one especially with WC or possibly the patient trying to be reimbursed from their accident insurance. If the record is coded with an M dx for pain in joint, etc. and no injury or external cause.
The provider has to differentiate in the record if something is acute or chronic and hopefully (although I know not always done if sub-par documentation) indicate the mechanism of injury. You can look for key words like traumatic, new, recent vs. chronic, old, recurrent to decide.
You are looking for the ICD-10 guidelines for Chapter 13, b. Acute traumatic versus chronic or recurrent musculoskeletal conditions. I think if you read that it will answer your question.

 

[thomas7331]

I agree, you can only code from the guidelines based on documentation - you can't make assumptions. If the provider diagnoses the patient with pain, then that's what you have to code. In order to code an injury, there needs to be an injury of some kind documented - bruise, scrape, burn, laceration, fracture, or even just 'injury'. But sometimes a patient will come in after an accident, and the physician cannot find any injury to the body, in which case you can only code the symptoms - you can't assume it's an injury unless the provider says so.

 

[PaigeMatthews]

I agree, you can only code from the guidelines based on documentation - you can't make assumptions. If the provider diagnoses the patient with pain, then that's what you have to code. In order to code an injury, there needs to be an injury of some kind documented - bruise, scrape, burn, laceration, fracture, or even just 'injury'. But sometimes a patient will come in after an accident, and the physician cannot find any injury to the body, in which case you can only code the symptoms - you can't assume it's an injury unless the provider says so.

So for an example .. Doctor states in the HPI, patient complaining of right knee pain patient was injured slipping on water at home but then down in the assessment/plan, states right knee pain likely traumatic soft tissue injury - such as sprain of musculature - follow up after MRI. Code to pain?

 

[cfordCPC]

So for an example .. Doctor states in the HPI, patient complaining of right knee pain patient was injured slipping on water at home but then down in the assessment/plan, states right knee pain likely traumatic soft tissue injury - such as sprain of musculature - follow up after MRI. Code to pain?

Yes, code right knee pain and external dx code for slipping on water.