P.T. CODING       7/10/24

POST-OP TRAUMATIC – Pain, stiffness, & then the injury- “S” code ending with a “D”. (No “Z” code needed)

FRACTURES (Post-op or not) – Pain, stiffness, & then the fracture “S” code ending with a “D”. (No “Z” code needed)

DISLOCATIONS – Pain, stiffness, & then the dislocation “S” code ending with a “D”. (No “Z” code needed)

SPRAINS AND STRAINS – Code the “S” code ONLY - ending with a “D”.

NON TRAUMATIC DIAGNOSIS – Just code the DX itself – No pain or stiffness needed – No “D” at the end. (OA, Trochanteric bursitis, Shoulder impingement...)

***P.T. orders cannot be billed with just a “Z” code – must have another numerical code with it***

PAIN IN LIMB

Arm – M79.601/M79.602 Thigh – M79.651/M79.652

Upper Arm – M79.621/M79.622 Lower leg – M79.661/M79.662

Forearm – M79.631/M79.632 Foot – M79.671/M79.672

Hand – M79.641/M79.642 Toes – M79.674/M79.675

Finger – M79.644/M79.645

Effusion of joint (swelling) M25.4_ _  (Knee – M25.461/M25.462, Ankle – M25.471/M25.472)

Muscle weakness (generalized) – M62.81

PAIN IN JOINT STIFFNESS

Shoulder – Rt – M25.511 Shoulder – Rt – M25.611

Shoulder – Lt – M25.512 Shoulder – Lt – M25.612

Elbow – Rt – M25.521 Elbow – Rt – M25.621

Elbow – Lt – M25.522 Elbow – Lt – M25.622

Wrist – Rt – M25.531 Wrist – Rt – M25.631

Wrist – Lt – M25.532 Wrist – Lt – M25.632

Hand – Rt – M25.541 Hand – Rt – M25.641

Hand – Lt – M25.542 Hand – Lt -  M25.642

Knee – Rt – M25.561 Knee – Rt – M25.661

Knee – Lt – M25.562 Knee – Lt – M25.662

Hip – Rt – M25.551 Hip – Rt – M25.651

Hip – Lt – M25.552 Hip – Lt – M25.652

Ankle/Foot – Rt – M25.571 Ankle – Rt – M25.671

Ankle/Foot – Lt – M25.572 Ankle – Lt – M25.672

Foot – Rt – M25.674

Foot – Lt – M25.675

DME

DME cannot be billed for COMFORT or for PAIN.

ALL DME gets coded with the original dx.

P.T. CODING                                                                                   6/18/24                

POST-OP NON-TRAUMATIC – Pain, stiffness, & then……………Z47.89

POST-OP TRAUMATIC – Pain, stiffness, & then……….Injury-S code – ends with a D   (No Z code)

POST-OP JOINT REPLACEMENTS – JOINT pain, stiffness & then……………..Z47.1 and Z96.6**

Shoulder – Z96.61_      Hip – Z96.64_      Knee – Z96.65_     (End with a 1-right or 2-left)

FRACTURES – Pain, stiffness and then the fracture “S” code ending with a “D” (No Z code).

DISLOCATIONS – Pain, stiffness and the dislocation “S” code ending with a “D”(No Z code).

SPRAINS AND STRAINS – Code the “S” code ONLY – ending with a “D”.

NON-TRAUMATIC DIAGNOSIS  - Just code the DX – No pain or stiffness needed, No “D” at the end if not traumatic.  (OA, Impingement, Bursitis………)

****P.T. orders cannot be billed with just a “Z” code – must have another numerical code with it****

PAIN IN JOINT STIFFNESS

Knee – Rt - M25.561 Knee – Rt – M25.661

Knee – Lt – M25.562 Knee – Lt – M25.662

Shoulder – Rt – M25.511 Shoulder – Rt – M25.611

Shoulder – Lt – M25.512 Shoulder – Lt – M25.612

Hip – Rt – M25.551 Hip – Rt -  M25.651

Hip – Lt – M25.552 Hip – Lt – M25.652

PAIN IN LIMB

Leg – Rt – M79.604 Thigh – Rt – M79.651 Lower Leg – Rt -  M79.661

Leg – Lt – M79.605 Thigh – Lt – M79.652 Lower Leg – Lt -  M79.662

Arm – Rt – M79.601 Upper Arm – Rt – M79.621 Forearm – Rt -  M79.631

Arm – Lt – M79.602 Upper Arm – Lt – M79.622 Forearm – Lt -  M79.632

Effusion of joint(swelling) M25.4_ _  (knee – M25.461/M25.462……..ankle – M25.471/M25.472)

Muscle weakness(generalized) – M62.81

Meniscal tears

Traumatic/acute MMT – Complex – S83.231D/S83.232D (any traumatic “horn” tears are coded as complex)

Traumatic/acute LMT – Complex – S83.271D/S83.272D

MMT/internal derangement/old injury – anterior horn – M23.211/M23.212

MMT/internal derangement/old injury – posterior horn – M23.221/M23.222

LMT/internal derangement/old injury – anterior horn – M23.241/M23.242

LMT/internal derangement /old injury – posterior horn – M23.251/M23.252

Rotator cuff tears

Traumatic/acute RCT – S46.011D/S46.012D

Non-traumatic RCT partial/incomplete – M75.111/M75.112

Non-traumatic RCT complete – M75.121/M75.122

Traumatic/acute SLAP tear – S43.431D/S43.432D

Degenerative/chronic labral tear – M24.111/M24.112

DME

DME can NOT be given for pain – MUST have a true DX.

L1852/ACL – If the patient has NOT had sx then – S83.511D/S83.512D

L1852/ACL/Post-op – then you use instability – M23.8X1/M23.8X2

L1852/OA – M17.11/M17.12(primary) or M17.31/M17.32(post traumatic)

EXAMPLES

P.T. order for right shoulder traumatic RTC post-op – M25.511, M25.611, S46.011D

P.T. order for right shoulder non-traumatic RCT post-op – M25.511, M25.611, Z47.89

P.T. order for right shoulder non-traumatic RCT – (partial or complete?) M75.111 OR M75.121

P.T. order for right knee OA – M17.11

P.T. order for right knee TKR (also partial) – M25.561, M25.661, Z47.1, Z996.651

P.T. order for right knee traumatic MMT post-op – M25.561, M25.661, S83.231D (complex?)

P.T. order for right knee internal derangement/old MMT post-op – M25.561, M25.661, Z47.89

P.T. order for right knee patella femoral ligament sprain – S83.8X1D

P.T. order for right knee patella dislocation(lateral?) – M25.561, M25.661, S83.014D

P.T. CODING                                                                                   6/4/24        

POST-OP NON-TRAUMATIC – Pain, stiffness, & then……..Z47.89

POST-OP TRAUMATIC – Pain, stiffness, & then……...Injury-S code – ending with a D  (No Z code)

POST-OP JOINT REPLACEMENTS – Pain, stiffness, & then……..Z47.1 and Z96.6**

Shoulder – Z96.61_       Elbow – Z96.62_       Wrist – Z96.63_      Finger – Z96.69_ 

(End with a 1=right  or  2=left)

FRACTURES – Pain, stiffness, & the fracture “S” code ending with a “D”.(No Z code for non-op)

DISLOCATIONS – Pain, stiffness, & the dislocation “S” code ending with a “D”.

SPRAINS AND STRAINS – Code the “S” code ONLY - ending with a “D”.

For Therapy ALL “S” codes should end with a D.

NON-TRAUMATIC DIAGNOSIS  - Just code the dx – No pain or stiffness needed – No “D” at the end.  (OA, Impingement, Bursitis, DeQuervains………)

PAIN IN JOINT STIFFNESS PAIN IN LIMB

Shoulder – Rt – M25.511 Shoulder – Rt - M25.611 Upper arm – Rt – M79.621

Shoulder – Lt – M25.512 Shoulder – Lt - M25.612 Upper arm – Lt – M79.622

Elbow – Rt – M25.521 Elbow – Rt – M25.621 Forearm – Rt – M79.631

Elbow – Lt – M25.522 Elbow – Rt – M25.622 Forearm – Lt – M79.632

Wrist – Rt – M25.531 Wrist – Rt – M25.631 Hand – Rt – M79.641

Wrist – Lt – M25.532 Wrist – Lt – M25.632 Hand – Lt – M79.642

Hand – Rt – M25.541 Hand – Rt – M25.641 Fingers – Rt – M79.644

Hand – Lt – M25.542 Hand – Lt – M25.642 Fingers – Lt – M79.645

Muscle weakness – M62.81         Effusion of jt. (swelling) – wrist – M25.43_ , hand – M25.44_

SPLINTS ONLY

All custom splints sent to O.T. must have the original diagnosis.

Use the original fracture code or the traumatic “S” code, or even just CMC OA – even if it is post-op and has already been fixed.   ***No PAIN codes and No “Z” codes for a splint***

EXAMPLES

P.T. order for right shoulder traumatic RCT post-op  -  M25.511, M25.611, S46.011D

P.T. order for right shoulder non traumatic RCT post-op  -  M25.511, M25.611, Z47.89

P.T. order for right distal radius intraarticular ORIF – M25.531, M25.631, S52.571D

P.T. order for rt distal radius extraarticular fracture/non-op – M25.531, M25.631, S52.551D

P.T. order for rt elbow joint replacement – M25.521, M25.621, Z47.1, Z96.621

P.T. order for rt wrist sprain (need specifics of WHAT is sprained – TFCC? Radiocarpal jt?.........)

TFCC – S63.591D,  Radiocarpal jot – S63.521D

P.T. order for rt index and long finger laceration (non joint?) M79.644, and then the laceration “S” code.  Will need the specifics on the laceration code – with or w/o FB, flexor, extensor….?

P.T. CODING                                                                                   6/11/24                

POST-OP NON-TRAUMATIC – Pain, stiffness, & then………Z47.89

POST-OP TRAUMATIC – Pain, stiffness, & then……….Injury-S code – ends with a D   (No Z code)

POST-OP JOINT REPLACEMENTS – Pain, stiffness, & then………………..Z47.1 and Z96.6**

Ankle – Z96.66_     Toe – Z96.698      Knee – Z96.65_      

(End with a 1-right or 2-left)

FRACTURES – Pain, stiffness and the fracture “S” code ending with a “D”. (No “Z” code)

DISLOCATIONS – Pain, stiffness and the dislocation “S” code ending with a “D”.

SPRAINS AND STRAINS – Code the “S” code ONLY – ending with a “D”.

NON-TRAUMATIC DIAGNOSIS  - Just code the DX - No pain or stiffness needed. No “D” at the end if not traumatic  (OA, Fasciitis, PTTD…….)

PAIN IN JOINT STIFFNESS PAIN IN LIMB

Ankle/Foot – Rt – M25.571 Ankle – Rt – M25.671 Foot – Rt – M79.671

Ankle/Foot – Lt – M25.572 Ankle – Lt – M25.672 Foot – Lt – M79.672

Foot – Rt – M25.674 Toes – Rt – M79.674

Foot – Lt – M25.675 Toes – Lt – M79.675

Knee – Rt – M25.561 Knee – Rt – M25.661 Lower Leg – Rt – M79.661

Knee – Lt – M25.562 Knee – Lt – M25.662 Lower Leg – Lt – M79.662

Effusion of joint(swelling) Rt foot – M25.474…………. Lt foot – M25.475

Effusion of joint(swelling) Rt ankle – M25.471………..Lt ankle – M25.472

Effusion of joint(swelling) Rt knee – M25.461…………Lt knee – M25.462

Muscle weakness (any) – M62.81

****P.T. orders can NOT be billed with just a “Z” code – has to have another numerical code with it.****

  EXAMPLES

P.T. order for Rt foot plantar fasciitis – M72.2

P.T. order for Rt distal fibula fx (displaced or non displaced?) (lat. Malleolus) – M25.571, M25.671, S82.64XD

P.T. order for post-op ORIF Rt displaced distal fibula fx – M25.571, M25.671, S82.61XD

P.T. order for post-op Rt hallux valgus bunion correction – M25.571, M25.671, Z47.89

P.T. order for post-op Rt ankle arthroplasty(total jt) – M25.571, M25.671, Z47.1, Z96.661

P.T. order for traumatic Rt Achilles tendon tear – S86.011D

P.T. order for post-op acute Rt Achilles tendon repair – M25.571, M25.671, S86.011D

P.T. order for non-traumatic Rt  Achilles tendon tear – M66.361

P.T. order for non-traumatic Rt. Achilles tendon repair – M25.571, M25.671, Z47.89

P.T. order for Rt ankle sprain (Need specifics – WHAT is sprained – ATFL, CCF, Deltoid…?)

ATFL – S93.491D

CCF – S93.411D

Deltoid – S93.421D