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Post Op Pain @ Site Beyond 90 day global

  1. #1
    Location
    Fayetteville,NC
    Posts
    23
    Question Post Op Pain @ Site Beyond 90 day global
    Medical Coding Books
    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!

  2. #2
    Location
    North Carolina
    Posts
    3,126
    Default
    Quote Originally Posted by Islandboy View Post
    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!
    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.

  3. #3
    Location
    Fayetteville,NC
    Posts
    23
    Wink
    Mary,

    Thank you for your quick reply. Yes, no "V" on 338.28 chonic post op pain- I applied DX as you recommended!

    Joe

  4. #4
    Location
    North Carolina
    Posts
    3,126
    Default
    Quote Originally Posted by Islandboy View Post
    Mary,

    Thank you for your quick reply. Yes, no "V" on 338.28 chonic post op pain- I applied DX as you recommended!

    Joe
    Mary? You mean Rebecca...

    Happy to help...

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