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Post Op Pain @ Site Beyond 90 day global

C

CapeCodYankee

Contributor
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23
Location
Dennis Port, MA
New to ortho coding/billing and would like someones' opinion/guidance on DX to apply. Patient had ORIF (ankle)surgery on 03/16/10 by our orthopeadic surgeon. Patient had follow-up care during 90 day global period, but returns to clinic complaining of chronic pain in ankle & is seen on 07/14/10- we are now beyond 90 day global period for this surgery.

I am coding 99212 for E&M o.v. charge, but should I be applying DX of 719.47 (pain in ankle) or V338.28 (post op pain)? I want to ensure payment from Medicare on this visit since it is outside 90 day global & am worried by applying the "V" DX it will cause MCR to question claim & delay payment.
Can anyone give me their suggetions on which DX is appropriate? Thanks in advance!
 
Islandboy said:
New to ortho coding/billing and would like someones' opinion/guidance on DX to apply. Patient had ORIF (ankle)surgery on 03/16/10 by our orthopeadic surgeon. Patient had follow-up care during 90 day global period, but returns to clinic complaining of chronic pain in ankle & is seen on 07/14/10- we are now beyond 90 day global period for this surgery.

I am coding 99212 for E&M o.v. charge, but should I be applying DX of 719.47 (pain in ankle) or V338.28 (post op pain)? I want to ensure payment from Medicare on this visit since it is outside 90 day global & am worried by applying the "V" DX it will cause MCR to question claim & delay payment.
Can anyone give me their suggetions on which DX is appropriate? Thanks in advance!
Click to expand...

V338.28 doesn't exist. I think you meant 338.28; which does represent "other chronic post-operative pain". If the documenatation supports it, I would elect to go with 338.28 since you've mentioned "chonic". The guidelines state that "routine or expected post-op pain immediately after surgery should not be coded"...your scenario is out of the global period.
 
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