Resolved Cast pain

[MaryW_64032]

Pt has L wrist fracture and was put in a cast. Comes back to the ED the next day as having pain due to cast MD gives pain meds and refers him back again to orthopedist who he will see tomorrow.

Coding clinic 2013 4 th quarter same scenario but MD adjust the cast and puts an ace bandage over it. CC States to assign fitting and adjusting of cast as the focus of care was for adjusting the cast and not the fracture.

in my top scenario would I only code for wrist pain with a history of a fracture?
thank you

 

[Lori]

Since the cast is the cause of the pain not the fracture the coding clinics advice is correct & the pain is not related to the fracture itself so they are being seen for the cast causing the pain not the fracture although it is a subsequent visit for the fracture. A history of fracture does not apply as it is still a current healing fracture as well.

G89.18
Other acute postprocedural pain (There seems to be no specific codes for pain due to an external device such as a cast only internal devices so this does not seem to fit well to me since the pain is not from the procedure but it is related to the procedure in that the cast was part of the treatment).

Z46.89
Encounter for fitting and adjustment of other specified devices
Encounter for fitting and adjustment of other devices; Fitting and adjustment of cast done; Fitting or adjustment of cast; Encounter for fitting and adjustment of wheelchair

S62.92XA
Unspecified fracture of left wrist and hand

 

[Jennifer]

The patient was seen in the ER and assigned a global fracture code or an E/M visit code? If it is the same provider/same TIN and a global was charged, then no visit charge can take place for this second day so the diagnosis wouldn't matter. If an E/M code and cast code was charged, then you can bill an E/M visit with a diagnosis to fit the scenario.

The wrist pain is due to the cast. M25.53- could be an option - my version of ICD10CM includes a coding tip: "These codes should be used when 1/the cause of the pain is unknown; 2/the pain is a sequela of an injury; 3/in conjunction with a G89 code. Do not use these codes with conditions where pain is integral." Coding guidelines indicate "any current, acute injury should be coded to the appropriate injury code from chapter 19." So I would go with the S- diagnosis assigned on the first day (as Lori suggested). I would not use the Z code as it may not describe the incident - fitting/adjustment doesn't seem to have taken place.

(Casts typically are not placed right away on fractures, splints are as the area will swell, especially if they don't keep it elevated. They usually need a couple of days for the swelling to go down before a cast is applied. So I can see how this scenario happens and how the CC2013 adjusted the cast - they probably cut it and applied the ace bandage - the same as a splint.)

 

[MaryW_64032]

Since the cast is the cause of the pain not the fracture the coding clinics advice is correct & the pain is not related to the fracture itself so they are being seen for the cast causing the pain not the fracture although it is a subsequent visit for the fracture. A history of fracture does not apply as it is still a current healing fracture as well.

G89.18
Other acute postprocedural pain (There seems to be no specific codes for pain due to an external device such as a cast only internal devices so this does not seem to fit well to me since the pain is not from the procedure but it is related to the procedure in that the cast was part of the treatment).

Z46.89
Encounter for fitting and adjustment of other specified devices
Encounter for fitting and adjustment of other devices; Fitting and adjustment of cast done; Fitting or adjustment of cast; Encounter for fitting and adjustment of wheelchair

S62.92XD
Unspecified fracture of left wrist and hand

Can you tell me why D or refer me somewhere in the book please ? I just thought any “new” fracture as it’s the day after the diagnosis of the fracture is A. Thank you

 

[Lori]

My apologies I updated it as I copy pasted the code & forgot to charge it.