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Would you code injury?

  1. Default Would you code injury?
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    Case scenario: Patient presents for recheck of knee pain in the clinic today. Was initially seen in the ER over the weekend by same physician for this knee injury. Slipped on the ice and his foot went under bumper of car hitting his knee. Aspirated the knee joint today. Diagnosis of knee pain. What is the correct diagnosis codes for this visit. If you code knee pain 719..46 and the E codes, insurance will not recognize as an injury because have not used an 800 or 900 code. Insurance companies generally look at the first diagnosis code and often times pay 100% on accidents. Can we code knee injury 959.7, then knee pain 719.46, then the E codes? Please advise. Thanks.

  2. Default
    Generally, you shouldn't use E codes unless you have an 800 or 900 dx code. You can't code it as an injury unless the phy documents that it's an injury. If he documents that the pain is due to the injury, then code the 959.7 knee injury, then the E-Codes. I wouldn't code the knee pain as that is part of the injury code. You are right, there are some insurance companies that have an accident rider and will pay 100% for an injury, but they want an 800 or 900 diagnosis code.
    ajo

  3. Default E code ONLY for initial tx
    Quote Originally Posted by mrolf View Post
    Case scenario: Patient presents for recheck of knee pain in the clinic today. Was initially seen in the ER over the weekend by same physician for this knee injury. Slipped on the ice and his foot went under bumper of car hitting his knee. Aspirated the knee joint today. Diagnosis of knee pain. What is the correct diagnosis codes for this visit. If you code knee pain 719..46 and the E codes, insurance will not recognize as an injury because have not used an 800 or 900 code. Insurance companies generally look at the first diagnosis code and often times pay 100% on accidents. Can we code knee injury 959.7, then knee pain 719.46, then the E codes? Please advise. Thanks.

    Per guidelines, E codes should NOT be assigned for subsequent tx; To be assigned ONLY for an initial encounter of an injury (initian tx)
    what was the indication for the px (aspiration), did the Dr provide the finding (like effusion),
    if yes, need to assign it (as pain is integral)+ V15.59 (to reflect the prior injury)

    (IF Dr performed any surgery or aspiration prior too then I'd assign V58.43.)
    Last edited by msrd_081002; 03-04-2011 at 02:00 AM.
    Thanks

  4. #4
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    you CAN use E codes in conjunction with any other diagnosis code in the book including a V code. Yes The above poster is correct that the E code is assigned only for the initial tx. However after the initital injury and the initital tx, what you have now is residual from the injury (the knee pain) which is the late effect, and you can code a late effect code with the knee pain, so look in the 905-909 section for an appropriate late effect from injury code, in addition if appropriate there are late effect E codes that can be used as well.

    Debra A. Mitchell, MSPH, CPC-H

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