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steroid injection pubic ramus fracture as 27193?

Julie Posted Wed 16th of October, 2013 08:08:41 AM

Patient with a closed pelvic ring/pubic ramus fracture was treated with a steroid injection for pain relief 4 months after the original injury. Physician coded it as '20551' and '27193'. Is 27193 the correct code for this injection? And do I need two separate diagnosis for '20551' and '27193'? I know I need modifier 59 on one of them. I am also unclear as to the difference between diagnosis code 905.1 and V54.19 - is one more appropriate than the other?

pertinent dictation:
"Under AP fluoroscopic guidance at 22gauge 3 1/2 inch spinal needle was advanced into the area of fracture with correct positioning confirmed on AP and lateral fluoroscopy. Injection of 2 mL of contrast revealed the spread over the entire fracture location both proximal and distal he no spread of contrast into the peritoneum/bladder.exterior of 0.5% Bupivacaine 8 mL plus Betamethasone 3 mg was injected following negative aspiration."


SuperCoder Answered Wed 16th of October, 2013 22:48:52 PM


I want to be a little more clearer on this.

"Is 27193 the correct code for this injection? "

27193 stands for Closed treatment of pelvic ring fracture, dislocation, diastasis or subluxation; without manipulation. Was it performed this time or previously.?


Julie Posted Thu 24th of October, 2013 05:00:40 AM


My physician has not done a manipulation at all this visit, or at any other time. The only fracture service was the steroid injection for pain control on this visit.


SuperCoder Answered Fri 25th of October, 2013 16:24:29 PM

If I'm understanding the follow-up comment correctly, the physician only administered an injection for pain relief. He didn't do any type of manipulation, which means he shouldn't bill 27193.

If 20551 is appropriate for the injection administered, I think that's the only code that's reportable. The documentation seems to fit with a tendon-type injection, so 20551 could be correct. If there are other notes specifying muscles or nerves injected, then those are the codes to report because they'll be more specific about the procedure.

There's also the question of appropriate diagnosis -- V54.19 and/or 905.1. I don't think 905.1 is appropriate because it's for late effect of spinal or trunk fracture. A better fit might be 905.4, which is for late effect of fracture of lower extremities. V54.19 falls into a category of codes used to "indicate a reason for care in patients who may have already been treated for some disease or injury not now present," according to CPT notes. I think the determining factor between whether V54.19 or 905.4 is more accurate depends on the patient's situation. My understanding is that the V code is for treatment that relates back to a previous problem, but the original problem isn't still in existence. 905.4, on the other hand, is for late effects -- meaning the patient is still experiencing problems that can be traced back to the original surgery/condition/etc.

My guess is the patient must still be experiencing problems, or he/she wouldn't be having steroid injections 4 months after the injury and original treatment. That makes me think the late effects 905.4 might be more appropriate. But, the coder needs to check through all the notes again and verify things with the physician to be sure this is the correct way to look at things.

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