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Anesthesia Coding Alert

READER QUESTIONS:

Distinguish 727.61 From 840.4 With Ease

Published on Wed Jan 28, 2009

Question: In treating pain stemming from an injury to the rotator cuff, how do you determine which code to use: 727.61 or 840.4?

Nebraska Subscriber

Answer: Miscoding either one of these scenarios is a fairly common mistake. Typically, 840.4 (Sprains and strains of shoulder and upper arm, rotator cuff [capsule]) should be used for an acute injury, while 727.61 (Complete rupture of rotator cuff) is used to report a chronic condition. The difference is traumatic versus nontraumatic. Sometimes you may find clues based on the patient's age and whether it was accident- or sportsrelated.

You should look for supporting documentation to determine if the rotator cuff has suffered a traumatic (840.4) versus non-traumatic (727.61) tear, sprain, strain, or rupture. You'll see the non-traumatic diagnosis more frequently in older patients.

If you can't find a definitive diagnosis in the documentation -- for example, if the documentation states "rotator cuff syndrome"-- use 726.10 (Disorders of bursae and tendons in shoulder region, unspecified).

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