Orthopaedic Diagnosis Coding Only

cwilson3333

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If a patient has a medical condition that would alter or affect the Orthopedic Doctor's plan of treatment, should the diagnosis for the other medical condition [for example, heart disease], be included on the claim submission. Aetna denied one of my claims where I had included a "cardiac disease code" on my claim as this is not a condition the Orthopedic Doctor is treating.

Waiting for the Right Answer .

Thanks
 

mitchellde

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Yes you would list it in the claim if the provider included the diagnosis as one that was managed , controlled, or treated, or if the provider indicated how the diagnosis was affecting rage standard routine plan of care for the ortho problem. The only line item CPT code the heart disease would be linked to would be the E&M.. You would not link it to any other ortho procedure codes.
 

ladymatthew

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I code dx that can affect the management of the orthopedic problem all the time, including hypertension/heart disease, smoking, etc.... I haven't had any issues with claim denials due to those codes but I do only attach them to the E/M code for submission :)
 

cwilson3333

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Orthopedic Diagnosis Coding

Yes you would list it in the claim if the provider included the diagnosis as one that was managed , controlled, or treated, or if the provider indicated how the diagnosis was affecting rage standard routine plan of care for the ortho problem. The only line item CPT code the heart disease would be linked to would be the E&M.. You would not link it to any other ortho procedure codes.

Thank you. My thoughts exactly.
 

cwilson3333

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Orthopedic Diagnosis Coding

I code dx that can affect the management of the orthopedic problem all the time, including hypertension/heart disease, smoking, etc.... I haven't had any issues with claim denials due to those codes but I do only attach them to the E/M code for submission :)

And thank you also.
 
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