Pain after knee replacement surgery

momo2

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Hello,

Need advice on how to code if provider states in the Assessment and Plan:

Left knee pain (M25.562) - stable

Status Post Left knee replacement (Z96.652)

My training has been that since the patient has had a left knee replacement (hence, no knee) then the knee pain is reported as a T84.84 code and NOT M25.562 (left knee pain).

Appreciate any feedback!!
 

Orthocoderpgu

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Need more information than you are giving. Are you speaking about this "During the global period"? Or after the global period? Or a year or two past the global period? There is going to be a small amount knee pain after its replaced. If the components are well placed, the pain should subside soon after the 90 day is over. If your within the global I would use the Z47.1 with Z96.652 for the visits, and even use them for standard post op visits where the patient has no real complaint but the physician needs to do a small exam and X-rays to make sure the components are still secure. The "T84.84" indicates that there is pain related to the TKA components at a time when there really should not be and in this situation the physician would be discussing or contemplating a revision. But then again, many docs put down pain in the assessment when the body of the note does not reflect it either. Your going to need to find out the timeline of each patient and identify which situation they are in so you can code correctly.
 

momo2

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Thank you for responding.

Because I currently participate in prospective coding for PCP outpatient offices, I would have no idea about "global period" status.

My provider is not providing "aftercare" rehabilitation services. He/She is only following up with the patient after surgery has been completed to see how they're doing.

Just curious, as after the knee replacement, you mentioned that there is going to be a small amount of pain, but that's probably around the joint, possibly from swelling?

At this point, since I am responsible for provider education when selecting codes, and since we are not Ortho docs, I'm not sure how to educate in a primary office care setting. I'm assuming the patient may be experiencing some type of pain around where the joint was replaced. Perhaps just using a general Pain code would be more appropriate (because the knee is no longer there).

Appreciate your feedback as I will also be putting together Best Practice documentation for my group to follow.
 

Orthocoderpgu

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With the information given, and the fact that you are basically coding blind since you can't even tell if the patient is in a global period or not, I would just use Z47.1 with the Z code to identify which joint was replaced. Due to the bone being cut there would be some initial pain/swelling but this would subside quickly. If you are in a teaching situation I would let the physicians know not to document "pain" unless the patient is really experiencing it as a symptom. Since the docs you are dealing with did not perform the arthroplasty, nor would do the revision, I would leave the pain evaluation to the surgeon that performed the arthroplasty and/or the surgeon that may perform the revision. Patient's with joint replacements are usually seen once a year by the surgeon that performed the surgery to make sure there are no complications and that the hardware is still firmly in place.
 

momo2

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With the information given, and the fact that you are basically coding blind since you can't even tell if the patient is in a global period or not, I would just use Z47.1 with the Z code to identify which joint was replaced. Due to the bone being cut there would be some initial pain/swelling but this would subside quickly. If you are in a teaching situation I would let the physicians know not to document "pain" unless the patient is really experiencing it as a symptom. Since the docs you are dealing with did not perform the arthroplasty, nor would do the revision, I would leave the pain evaluation to the surgeon that performed the arthroplasty and/or the surgeon that may perform the revision. Patient's with joint replacements are usually seen once a year by the surgeon that performed the surgery to make sure there are no complications and that the hardware is still firmly in place.
Thank you very much!
 
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