tci Part B Insider - 2014 Issue 27

Part B Coding Coach: Refer to These Rotator Cuff Upgrade Strategies to Guarantee Your Claim's Success

Is your payer’s advice lacking? Here’s how to create internal guidelines for chronic/acute conditions. Upgrading a rotator cuff strain to a torn rotator cuff can land your claim in troubled waters, especially as local carrier direction can be nonexistent. If your insurance adjuster lacks specific chronic/acute advice, create your own internal guidelines -- our experts show you how. Scenario: Suppose a patient suffers a rotator cuff strain (840.4) while lifting boxes at work. The patient’s workers’ compensation carrier reimburses the practice for several months, after which the orthopedist decides that the patient requires surgery to...

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