Wiki Odd shoulder case

[Desperate Denise]

This will be final shoulder thing with this audit - sorry to trouble everyone - I just don't know where to turn at this point.

Patient has a history of a distal clavicle excision several years ago. She has had continued pain in the region. Doctor diagnosed the patient with clavicle AC joint arthritis, subacromial spur, cystic changes greater tuberosity and of course my favorite - status post distal clavicle excision. I used ICD.9 codes 733.22 for spur, 715.91 for OA and doc said to code for AC disloc 831.04. Should I have used 718.31 for recurrent?

He reported performing a partial claviculectomy (23120) and open AC dislocation with fascial graft (23552)

I coded it 23552 and 23120-51 - is that the right modifier and is it billable? I checked the CCI audit and there was no contraindication but I want to be sure before defending it.

Thank you so very much ----

 

[JMeggett]

This will be final shoulder thing with this audit - sorry to trouble everyone - I just don't know where to turn at this point.

Patient has a history of a distal clavicle excision several years ago. She has had continued pain in the region. Doctor diagnosed the patient with clavicle AC joint arthritis, subacromial spur, cystic changes greater tuberosity and of course my favorite - status post distal clavicle excision. I used ICD.9 codes 733.22 for spur, 715.91 for OA and doc said to code for AC disloc 831.04. Should I have used 718.31 for recurrent?

He reported performing a partial claviculectomy (23120) and open AC dislocation with fascial graft (23552)

I coded it 23552 and 23120-51 - is that the right modifier and is it billable? I checked the CCI audit and there was no contraindication but I want to be sure before defending it.

Thank you so very much ----

Looks good to me ~ keep 831.04 cuz the last time was several years ago, and it's a current issue. I don't add -51, but the carriers in your state may want you to add it. Doesn't make a diff in audit situation.
Jenna

 

[Desperate Denise]

Desperate D

Thanks again JMegget - I may be able to sleep tonite knowing I have some support and am getting there with these modifiers. Really appreciate your time. Thanks - Denise