tci ED Coding & Reimbursement Alert - 2006 Issue 8

You Be the Coder: File Without a Chronic Condition Dx?

Question: A patient with Group A hyperlipidemia (hypercholesterolemia) arrives at the ED with a dislocated shoulder she injured while driving a personal watercraft in the ocean. An x-ray reveals a fracture of the greater tuberosity. The physician treats the shoulder with manipulation. Should I include ICD-9 codes for her chronic condition on the claim?California SubscriberAnswer: It depends on the operative notes and the physician's course of treatment. If the doctor confirms that the patient's cholesterol level wasn't relevant to the treatment of the shoulder, you should:- report 23665 (Closed treatment of shoulder dislocation, with fracture of greater humeral...

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