Need Help w/dx code please help

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I have a indiana wc claim that i need help with dx code

dr. notes~internal disruption of right shoulder it states uncertain whether the long bicep tendon rupture if old or not but there is evidence og rotator cuff tendon injury the chief complaints are pain weakness joint stiffness of shoulder

should i code the pain weakness joint stiffness?

thank you
 

armen

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I have a indiana wc claim that i need help with dx code

dr. notes~internal disruption of right shoulder it states uncertain whether the long bicep tendon rupture if old or not but there is evidence og rotator cuff tendon injury the chief complaints are pain weakness joint stiffness of shoulder

should i code the pain weakness joint stiffness?

thank you
i would code pain in shoulder untill MD documents other Dx like rotatoe cuff injury
 

ANGIE337

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Dx help

remember you can never use possible or r/o or even consistant with or evidence of. you would need to go with the signs and symptoms in this case until there is a definate DX of rupture or tear.
 

vj_tiwari

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HEy :)

You mentioned like "it states uncertain whether the long bicep tendon rupture if old or not but there is evidence of rotator cuff tendon injury" so I think we can use 840.4 Rotator cuff sprain.

:confused:
 
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