Wiki Timeline to use for Rotator cuff tear ICD-9 codes

[hdavis34]

The ICD-9 codes that we use are of course generally... 727.61, 726.13 and the current code of 840.4 etc.

The majority of the surgeons are stating the tear occurred on this date which could be 2 weeks ago or 6 months ago. We have been coding the ones that are 90 days or more as 727.61 and 726.13 (depending on the tear itself) If it is within 90 days we are coding to current (840.4). We cant find any information that supports why we are coding that way (which everyone in the office has been doing for a very long time). Since the manual shows that the codes are separated by traumatic and non-traumatic we are starting to question if our current coding is way off base.

I guess the main question would be, if the tear occurred 8 months ago because the patient slipped and fell (traumatic injury at the time) would it be correct to code it as 727.61 or 726.13 (for being old) or because it was traumatic we should use the current/ traumatic code 840.4 ignoring the fact that it has happened awhile ago?

Any input would be great! Thanks!

 

[ajb1986]

If the tear was of a traumatic nature you would code it as traumatic. The way I was told, because I recently had a similar situation, by an auditor at my hospital is if the ligament had a previous tear at the same location that was previously treated you could use the old tear dx code. In this case I would use the rtc traumatic tear with an ecode for wherever they were injured. Also if they are medicare check the lcd guidelines for the cpt codes used in surgery if they had surgery