Wiki "tendonopathy"

[jfolz]

I have a physician that refuses to dictate anything other than "tendonopathy" when he treats a non-traumatic rotator cuff tear. I have addressed the office, and while I was unable to speak directly to the physician, they emailed me that his usage of the term "tendonopathy" is to indicate that the tear is due to a disease process and not trauma. (DER!) I queried him on a case that insurance was denying due to the non-specificity of the diagnosis, and asked the disease process responsible for the affected tendon and his answer was "I don't know". (Obviously he doesn't care either.) This event resulted in a denial for the patient.

My question is this... can anyone suggest a better code than M6792x (unspecified disorder of synovium and tendon) or is that the best I have with this uncooperative surgeon?

 

[jfolz]

clarification-

He will give me "rotator cuff tear" and then "bicipital tendonopathy". I can get the rotator cuff tear but not a disease process for it.

 

[Orthocoderpgu]

I'm not following this

The biceps tendon is not part of the rotator cuff and is a separate issue.

Under the indications for the procedure the physician should be documenting if what he is treating is traumatic or not. If there is no indication of an accident or trauma, I would choose codes for degenerative pathology. My question is does he get more specific in the op note itself? Is the biceps swollen, unstable or out of the groove? If so you could use a diagnosis for one of those. Maybe ask if tendonopathy would be synonymous with tendonitis so you could use one of those codes?

 

[jfolz]

Thanks for the response!

I appreciate you taking the time to respond
We have been told to code the degenerative route unless there is mention of an accident, so we have been doing that and I guess I should have used "rotator cuff tendonopathy" to truly illustrate what I was specifically complaining about him normally dictating, but I wanted exact wording from an op-note in-hand and he usually throws that "bicep tendonopathy" in there as well. I do appreciate your response. He will generally only describe it as a rotator cuff tear and then describe it further as tendonopathy that he debrides the affected area(s), so no more detail than that. I do feel like he is probably wanting it coded as "tendonitis" but I can't get him to say that word in his dictation and I can't think of a good query that isn't leading him to say it. He is very reliant on templates (which I feel is poor practice anyway) and I think it would take an act of God and congress get him to edit one.
(I wish that we had a way to demand a certain quality of Operative Report. I always roll my eyes when we do new training exercises and get complete and beautiful op notes to code from with all of the necessary details. That's not real life!)

 

[Orthocoderpgu]

Problem solved?

If the concern is over the RTC repair, I would just use the M codes if not otherwise indicated.

It sounds like to me that he could be losing money because of they way he is dictating. Debridement that is not part of a restorative procedure (RTC reapair, tenodesis) can be billed as 29823 if documented. Just by stating that he debrided the "area" or "joint" does not allow you to do that.

My guess is that he is loosing money due to his documentation. I have one like that too and feel your pain.