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Resolved Diagnosis denials

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M25.551 is code for Pain in joint right shoulder
M54.5 is code for low back pain

Perhaps the DX suggests pain is classified elsewhere or a symptom of the DX or there is a multiple site code that works better.

Where more than one bone, joint or muscle is usually involved, such as osteoarthritis, there is a “multiple sites” code available.

The code for multiple sites is M15.3

13. Chapter
13: Diseases of the Musculoskeletal System and Connective Tissue (M00-M99) a. Site and laterality Most of the codes within Chapter 13 have site and laterality designations. The site represents the bone, joint or the muscle involved. For some conditions where more than one bone, joint or muscle is usually involved, such as osteoarthritis, there is a “multiple sites” code available. For categories where no multiple site code is provided and more than one bone, joint or muscle is involved, multiple codes should be used to indicate the different sites involved.
 
For primary care, they don't get that specific. It is weird I am getting a denial for the diagnosis and they are the only two on there.
 
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