Neurology & Pain Management Coding Alert

Question: A patient who was treated for a closed pelvic ring/pubic ramus fracture visited scheduled an appointment with practice. Our physician treated her with a steroid injection for pain relief (it’s been four months since the original injury but this was the first time our physician saw the patient). The physician marked 20551 and 27193 on the chart. Is 27193 correct for this injection? And do I need two separate diagnoses for 20551 and 27193? I know I’ll need to report modifier 59 with one of the codes. I’m also unclear as to the best diagnosis code to report. What do you suggest?

Delaware Subscriber 

Answer: Based on the information you provided, the physician only administered an injection for pain relief during this encounter. He didn’t do any type of manipulation or treatment of the fracture, which means he shouldn’t bill 27193 (Closed treatment of pelvic ring fracture, dislocation, diastasis or subluxation; without manipulation).

The physician’s choice of 20551 (Injection[s]; single tendon origin/insertion) could be correct, depending on documentation of the procedure. If the documentation seems to fit with a tendon-type injection, 20551 could be correct. If there are other notes specifying muscles or nerves injected, then those are the codes to report because they’ll be more specific about the procedure. Review the chart notes and query the physician if you need confirmation before submitting 20551.

A pelvic ring /pelvic ramus fracture originally is coded in the 808 ICD-9 section (Fracture of pelvis). The late effect code for fractures in this code range is 905.1 (Late effect of fracture of spine and trunk without spinal cord lesion). Report diagnosis 905.1 for late effect of injury classifiable to categories 805 or 807-809, which means it’s the correct choice in this case.