Question on one of the review questions in AAPC CPC study guide

[fredandstaceyhardiman@gmail.com]

Does anyone have the official study guide by AAPC and can answer a question from it?

 

[sls314]

Does anyone have the official study guide by AAPC and can answer a question from it?

I don't have a copy handy, but I might be able to answer the question if you ask it here.

 

[fredandstaceyhardiman@gmail.com]

For some reason this discussion forum won't allow me to post a photo of the scenario. So I have to find someone who has the book or I will have to write it all out. So here it goes...

Diagnosis: 1.Low back pain,2. Degenerative Lumbar Disc
Procedure: Bilateral facet joint injections of steroid at the L4-L5 and L5-S1 with fluoroscopic guidance

Scenario basically details the process of injection of Marcaine plain plus 80 mg of methylprednisolone and divided it between the four joints. The answer they are giving is Just M51.36. The reasoning is that low back pain is a symptom of degeneration of the discs. Which is fine, but when you read the guidelines for pain it states

I.C.6.1.a " When pain control or pain management is the reason for the admission ( patient with displaced intervertebral disc nerve impingement and presents for injection of steroid into the spinal canal) The underlying cause of the pain should be reported as an additional diagnosis, if known. "

I am assuming that this guide line can't be used because there is no wording that has acute, chronic, post-thoracotomy, post-procedural or neoplasm related.

 

[LisaAlonso23]

For some reason this discussion forum won't allow me to post a photo of the scenario. So I have to find someone who has the book or I will have to write it all out. So here it goes...

Diagnosis: 1.Low back pain,2. Degenerative Lumbar Disc
Procedure: Bilateral facet joint injections of steroid at the L4-L5 and L5-S1 with fluoroscopic guidance

Scenario basically details the process of injection of Marcaine plain plus 80 mg of methylprednisolone and divided it between the four joints. The answer they are giving is Just M51.36. The reasoning is that low back pain is a symptom of degeneration of the discs. Which is fine, but when you read the guidelines for pain it states

I.C.6.1.a " When pain control or pain management is the reason for the admission ( patient with displaced intervertebral disc nerve impingement and presents for injection of steroid into the spinal canal) The underlying cause of the pain should be reported as an additional diagnosis, if known. "

I am assuming that this guide line can't be used because there is no wording that has acute, chronic, post-thoracotomy, post-procedural or neoplasm related.

You're correct.

 

[fredandstaceyhardiman@gmail.com]

So this rule applies even though the reason for the encounter is for pain management. Thank you for your help!

 

[sls314]

So this rule applies even though the reason for the encounter is for pain management. Thank you for your help!

Correct.

The first part of the guideline "If the pain is not specified as acute or chronic, post-thoracotomy, postprocedural, or neoplasm-related, do not assign codes from category G89" rules out considering a code from G89.

The subheading (a) that you posted above doesn't override the main paragraph that preceeds it.

 

[fredandstaceyhardiman@gmail.com]

Ok, that makes sense. They also didn't code any of the medications injected. Is that because we wouldn't capture those unless it was a Medicare patient or a third-party that is known to cover such codes?