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Code for compression fracture lumbar

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Does anyone have any idea what diagnosis code should be used when a patient comes with compression fracture of lumbar for kyphoplasty procedure
 

thomas7331

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If you have no other documentation about the fracture (e.g. whether this is a pathological or a traumatic fracture), then this would code to category M48.5 - Compression fracture of vertebra NOS, so I would use M48.56XA for the lumbar site.
 

ashleighd

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I don't believe Medicare is covering the M48.5- code for Kyphoplasty anymore. You could use a M80.08X- or M80.88X- or the corresponding level code S32.0xxA code
 

ChattRiskCoder

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If you have no other documentation about the fracture (e.g. whether this is a pathological or a traumatic fracture), then this would code to category M48.5 - Compression fracture of vertebra NOS, so I would use M48.56XA for the lumbar site.
I agree with your coding @thomas7331 ; however, I was just recently dinged with the reasoning that you cannot index the compression fracture NOS code.
 

thomas7331

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I agree with your coding @thomas7331 ; however, I was just recently dinged with the reasoning that you cannot index the compression fracture NOS code.
I guess I could agree with that if they are strict with the guidelines, but then I don't think you can get to another code. How did they say the diagnosis should have been coded then, or did they say you should have queried the provider?
 

ChattRiskCoder

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I guess I could agree with that if they are strict with the guidelines, but then I don't think you can get to another code. How did they say the diagnosis should have been coded then, or did they say you should have queried the provider?
They said that the provider needs to document either pathological, traumatic/non-traumatic . If you go to the M48.50XA, the tabular tells you that it is used for collapsed vertebra NOS. Kind of frustrating.
 

ashleighd

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We do roughly 15 Kyphoplasties a month. If pathologic: M80.08xa or M80.88xa If traumatic: then S codes for the wedge compression type or you'd have to use the "Other Fracture type"
 
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