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Resolved Pain or injury code?

Hi all,
Seeking guidance on Chpt 13 guidelines. Cab anyone assist with the following 2 questions please?

1. Patient complains of low back pain for one week after experiencing a ground level fall.
Assessment/Plan #acute low back pain, rest and OTC pain reliever prn.
Would this be coded to pain (M54.5- low back pain) with external cause (W18.30-same level fall) or injury (S39.92XA-unspecified injury of lower back, initial encounter) with external cause (W18.30-same level fall)?

2. How would you code #T10 fracture (no other details) when note does not specify if pathological or traumatic?

Thank you in advance CCO!
 

EmilyM_67452

New member
BHAT® Cave
Outpatient Blitz
Hi Shannon,

Here are my thoughts.

1. Since the back pain was caused by the fall, I think this would be an injury and correctly coded with S39.92XA and appropriate external cause code.
(If anyone disagrees with this please correct me if I am wrong.)

2. If this is not a specified fracture (traumatic/pathologic), try to see if you can figure out under what the circumstance was where the injury occured if documented, or if you are able to you can send a query to the provider.
See these articles: http://www.hcpro.com/content.cfm?content_id=306884 , https://acdis.org/articles/qa-querying-etiology-traumatic-injuries, https://provider.amerigroup.com/docs/gpp/ALL_CARE_CF_V3I6CompressionFractures.pdf?v=202105220015

Hope this helps.

-Emily
 

Alicia

Director of Education
Staff member
Very good point Emily. However, you can use all three! The patient had a fall. What is the result, Injury & Pain.
 

Darcy

CCO Coach/Instructor - CPC, CPC-I
Staff member
If documentation states "acute low back pain" that is what should be coded. M54.5 - Low back pain
 
There is actuall a Z code for fall.
Instead of Z code what about external cause code W19.XXXA?
S39.92X-, W19.XXXA
Or
M54.5, W19.XXXA
Would the S or M code be more appropriate...is back pain caused by a fall considered an "injury" per chpt 13b guidelines or does the documentation need to specify "injury"?
 

Darcy

CCO Coach/Instructor - CPC, CPC-I
Staff member
Correct - all the documentation states is low back pain from the fall. No injury identified.
 
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