Wiki Pain code versus original finding from xray

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I need some major help. We have had several scenario's in our office regarding this matter. The first example is: Patient came to ER complaining of back pain. ER doctor ordered lumbar spine xray. Xray stated patient had osteoporosis. The xray report was coded with osteoporosis. We are being told this is wrong. Please help. Also, had patient come to ER with knee pain. Once again knee xray ordered. Xray report stated degenerative changes. The xray report was coded with degenerative changes. We are told this is wrong because the ER doctors do not treat this kind of stuff. Our reasoning is that the pain is caused from the degenerative changes. I would love some good input. Thanks again
 
I would have coded it the way you did for the same reasons you mentioned. I don't think it would matter if the ED treats those conditions or not. The fact of the matter is those are the diagnoses. I would be curious to see what other responses you receive.
 
If the payor wants ...

If the payor wants you to only code signs/symptoms that bring patient to ER, code it that way. It's not the most accurate code per ICD-9 guidelines, but it's not wrong.

F Tessa Bartels, CPC, CPC-E/M
 
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