tci ED Coding & Reimbursement Alert - 2005 Issue 11

READER QUESTIONS: Add Diagnosis for E Code

Question: A patient presented in the ED complaining of pain in his shoulder after a basketball game. The physician believed the patient sprained his rotator cuff, so I reported E927 (Overexertion). I then added -injured while playing basketball- to box 19. The carrier denied the claim, saying we didn't indicate the patient's injury. How should I resolve this?Georgia Subscriber Answer: The reason the insurer isn't reimbursing you is because technically, E927 doesn't describe an injury--you just use it to describe the external cause of the patient's injury. For the principal diagnosis, you should report a code that identifies...

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