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diagnosis code hip pain please !!

  1. Default diagnosis code hip pain please !!
    Medical Coding Books
    THE BLUE SHIELD INS IS REJECTING A CLAIM BECAUSE THEy SAID 719.45 HIP PAIN IS A INJURY CODE AND THEY ANT THE DATE OF INJURY AND HOW IT OCCURED. BUT THE PT WAS NOT INJURED AND HE HAS VARIUS JOINT ACHES AND PAIN PER DOCTORS NOTE. HE ALSO DIAGNOSIS THE PT WITH MULTIPLE ARTHRALGIA AND THE PT IS ONLY 7 YRS OLD.
    IS THERE SOMETHING NEW WITH JOINT PAIN CODES? I ALSO HAD A CLAIM REJECTION
    ON SHOULDER PAIN DX 719.41.

    THANK YOU IN ADVANCE
    MSMADDY
    Last edited by MsMaddy; 11-05-2010 at 12:23 PM.

  2. Default
    Arthralgia literally means joint pain.....

    Multiple Arthralgia would mean Joint pain in multiple joints....

    The coding guideline is as follows...." Do not code symptoms if there is a definite diagnosis" . If you have coded Arthralgia I would say Hip pain is included under it and therefore they would not pay for it as it is double dipping.....

    This is why your claims are getting rejected.... Although I am not a pro at billing any suggestions please..... I would want to know everybody's input.

    Thanks

  3. #3
    Location
    Colordo Springs Pikes Peak Coders
    Posts
    67
    Wink Joint Pain
    Hello-

    First of all, as you know, 719.45 is not an injury code. The insurance company is wrong by saying that. I think they are looking for a more definitive diagnosis and it is totally acceptable to use that code if the doctor is still trying to figure out what is causing the joint pain. I do billing and coding and more than likely, the insurance company will send a questionnaire to the patient's parents to fill out. My husband had shoulder pain and we received a questionnaire from the insurance company asking if it was due to an accident. It was not due to an accident. You might want to start submitting your claims by entering the first date the patient was seen for the joint pain on future claims to see if that helps. It might also help to resubmit or appeal the claim with dx code 719.49 for multiple joint pain since you said he has various joint aches. That would be the appropriate code to use in this case.

    Unfortunately, you will have to appeal the rejection since it has already been processed which takes time. Good luck!
    Arlene Andrew, CPC, CEDC, CPC-I
    Coding Quality Coordinator, ED/Ambulance
    UCHealth, Colorado

  4. Default
    Quote Originally Posted by MsMaddy View Post
    THE BLUE SHIELD INS IS REJECTING A CLAIM BECAUSE THEy SAID 719.45 HIP PAIN IS A INJURY CODE AND THEY ANT THE DATE OF INJURY AND HOW IT OCCURED. BUT THE PT WAS NOT INJURED AND HE HAS VARIUS JOINT ACHES AND PAIN PER DOCTORS NOTE. HE ALSO DIAGNOSIS THE PT WITH MULTIPLE ARTHRALGIA AND THE PT IS ONLY 7 YRS OLD.
    IS THERE SOMETHING NEW WITH JOINT PAIN CODES? I ALSO HAD A CLAIM REJECTION
    ON SHOULDER PAIN DX 719.41.

    THANK YOU IN ADVANCE
    MSMADDY
    I have no clue! Ummmm 959.6 is an INJURY code... 843.9 is an INJURY code, but 719.45 DEFINITELY is not an injury code. Wow. Have you called and talked to them? I so miss doing the billing with coding. There is no reason to need an e code and doi on a joint pain code. Now, if there is a sprain or mechanism of injury, then I get that, but this is a pain code.... arrgggg. Why do insurance companies have to make things so hard when it is so very straight forward?

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