What Medical Codes To Use For These Common Workout Injuries While Billing

What Medical Codes To Use For These Common Workout Injuries While Billing

Workouts and exercise provides great health benefits, but also come with risk of injuries, strains and sprains. Most common causes of workout injuries include poor posture, exercising before warming up body, repetitive motion, not taking enough rest between workouts, performing too strenuous exercise, improperly using proper equipment, twisting or pushing your body too hard. Physicians can rely on orthopedics medical coding services to report diagnoses and treatments, and ensure accurate claims submission.

ICD-10 Codes for Common Workout Injuries

Bicep tendon rupture

A biceps tendon tear can occur either at the shoulder or the elbow. Heavy weight lifting can stress on the biceps and cause the tendon to tear away from the bone, and even separation of the muscles from the bone.

  • M66.82 Spontaneous rupture of other tendons, upper arm
    • M66.821 Spontaneous rupture of other tendons, right upper arm
    • M66.822 Spontaneous rupture of other tendons, left upper arm
    • M66.829 Spontaneous rupture of other tendons, unspecified upper arm

Labral tear

Hip labral tear is mainly caused by exercises, sports-related activities or other physical activities which involve sudden twisting or long-distance running that can lead to joint wear or tear.

  • S43.43 Superior glenoid labrum lesion
    • S43.431 Superior glenoid labrum lesion of right shoulder
    • S43.432 Superior glenoid labrum lesion of left shoulder
    • S43.439 Superior glenoid labrum lesion of unspecified shoulder

Sternum fracture

The sternum protects the heart, lungs, and other major blood vessels. Pain in the sternum can occur during exercise or as a result of a variety of conditions or injuries. Sternum fractures usually occur as a direct result of trauma. Major symptoms include difficulty breathing, pain and swelling over the sternum.

  • S22.2 Fracture of sternum
    • S22.20 Unspecified fracture of sternum
      • S22.20XA …… initial encounter for closed fracture
      • S22.20XB …… initial encounter for open fracture
      • S22.20XD …… subsequent encounter for fracture with routine healing
      • S22.20XG …… subsequent encounter for fracture with delayed healing
      • S22.20XK …… subsequent encounter for fracture with nonunion
      • S22.20XS …… sequela

Low back pain

Strenuous workouts or heavy weight lifting can put strain on the muscles surrounding the spine, causing low back pain.

  • M54.50 Low back pain, unspecified
  • M54.51 Vertebrogenic low back pain
  • M54.59 Other low back pain

Pectoralis injury

Pectoralis injury refers to a tear in the large muscle which covers the chest. Pectoralis major strain may occur during weight training or bench press exercises when the muscle is forcibly contracted whilst in a stretched position.

  • S29.011A Strain of muscle and tendon of front wall of thorax, initial encounter
  • Y92.39 Other specified sports and athletic area as the place of occurrence of the external cause
  • Y93.B9 Activity, other involving muscle strengthening exercises

Knee injuries

Physical activities like running, jumping, stretching and bending can put a lot of strain on the knees, causing pain. Runner’s knee is a common injury caused by frequent bending of the knees during high-stress exercises.

  • S83 Dislocation and sprain of joints and ligaments of knee
    • S83.0 Subluxation and dislocation of patella
    • S83.1 Subluxation and dislocation of knee
    • S83.2 Tear of meniscus, current injury
    • S83.3 Tear of articular cartilage of knee, current
    • S83.4 Sprain of collateral ligament of knee
    • S83.5 Sprain of cruciate ligament of knee
    • S83.6 Sprain of the superior tibiofibular joint and ligament
    • S83.8 Sprain of other specified parts of knee
    • S83.9 Sprain of unspecified site of knee

Shin splint

Shin splint refers to the pain in the inner edge of the tibia or shinbone. Also referred to as medial tibial stress syndrome, the condition develops when the muscle and bone tissue in the leg become overworked by repetitive motions.

  • M76.81 Anterior tibial syndrome
    • M76.811 …… right leg
    • M76.812 …… left leg
    • M76.819 …… unspecified leg


Common among body builders, this condition is when the repetitive motion of lifting puts the tendon under strain and causes tightening over time. Also referred to as overuse tendinopathy, the condition can lead to rotator cuff tendinitis of the shoulder, and lateral epicondylitis, or tennis elbow.

  • M77.1 Lateral epicondylitis
  • M76.6 Achilles tendinitis
    • M76.60 Achilles tendinitis, unspecified leg
    • M76.61 Achilles tendinitis, right leg
    • M76.62 Achilles tendinitis, left leg
  • M75.1 Rotator cuff tear or rupture, not specified as traumatic


Physical activities such as lifting heavy weights can result in hernias due to increased pressure within the abdominal cavity. The condition usually occurs when correct lifting techniques are not followed.

  • K40 Inguinal hernia
  • K41 Femoral hernia
  • K42 Umbilical hernia
  • K43 Ventral hernia
  • K44 Diaphragmatic hernia
  • K45 Other abdominal hernia
  • K46 Unspecified abdominal hernia

Workout injuries are the result of repetitive and forceful motions. Treatment for workout injuries depends on the severity of the symptoms. Medications such as non-steroidal anti-inflammatory drugs such as ibuprofen and naproxen sodium are usually recommended to relieve pain and reduce inflammation. Corticosteroid injections are administered as a temporary solution to control the joint pain. Physical therapy programs help maximize hip range of motion and hip and core strength and stability. Surgery will be recommended only if conservative treatments don’t relieve symptoms.

Orthopedics is an extensive area and reporting diagnosis and treatments for various conditions can be complex. Expert orthopedic medical coding services can help physicians ensure accurate claims submission with the right codes and adherence to payer guidelines.

How A Cardiology Medical Billing Company Codes Heart Arrhythmias

Arrhythmia is a cardiac condition that affects the rate or rhythm of heartbeat. The heart beats too quick, too slow, or in an irregular pattern. Major factors that can cause the condition include valve disorders, high blood pressure, electrolyte imbalances, any infection, coronary artery disease, hyperthyroidism, excessive alcohol or caffeine, use of certain medications or stress. Primary care doctors, cardiologists, electrophysiologists or any specialists treating heart arrhythmias can rely on comprehensive medical coding services provided by experts to manage claim filing efficiently.

Common symptoms of this condition include fast or slow heartbeat, weakness or fatigue, shortness of breath, chest pain, sweating, anxiety, blurred vision, and fainting. Diagnosis tests that may be recommended to confirm an irregular heartbeat and look for conditions that can cause arrhythmias include Electrocardiogram (ECG or EKG), Echocardiogram, Holter monitor, Electrophysiological testing and mapping, MRI, and stress test.

Heart arrhythmia treatment may include medications, catheter procedures, ablation and therapy. Surgery may be recommended to correct this condition that can’t be controlled with medications or other non-surgical treatments.

ICD-10 Codes for Different Types of Arrhythmias

Heart arrhythmiais categorized by the speed of the heart rate. The two main types of arrhythmia are Tachycardia and Bradycardia. Tachycardiais too fast heart beat (more than 100 beats per minute) and Bradycardia is too slow heartbeat (less than 60 beats per minute).

  • R00 Abnormalities of heartbeat
    • R00.0 Tachycardia, unspecified
    • R00.1 Bradycardia, unspecified
    • R00.2 Palpitations
    • R00.8 Other abnormalities of heart beat
    • R00.9 Unspecified abnormalities of heart beat

Tachycardia types

Atrial fibrillation

This irregular and rapid heart rhythm can cause poor blood flow, stroke, blood clots in the heart, and even heart failure.

Atrial flutter

Here, the heartbeats are more organized and regular than atrial fibrillation. It can cause stroke. The condition can be paroxysmal or persistent.

Supraventricular tachycardia

Supraventricular tachycardia that starts above the ventricles refers to heartbeat that is abnormally fast. Factors such as age, thyroid issues, and congenital heart disease can increase the risk of this condition.

Ventricular fibrillation

With this condition, the heart fails to pump blood to the rest of the body and may cause sudden cardiac death. Common symptoms include loss of consciousness, chest pain, shortness of breath or nausea. It can even lead to a life-threatening emergency like a cardiac arrest.

Ventricular tachycardia

Caused by abnormal electrical signals in the ventricles, the condition can prevent the heart from pumping enough blood to the body and lungs.

Tachycardia Codes

  • I47 Paroxysmal tachycardia
    • I47.0 Re-entry ventricular arrhythmia
    • I47.1 Supraventricular tachycardia
    • I47.2 Ventricular tachycardia
    • I47.9 Paroxysmal tachycardia, unspecified
  • I48 Atrial fibrillation and flutter
    • I48.0 Paroxysmal atrial fibrillation
    • I48.1 Persistent atrial fibrillation
      • I48.11 Longstanding persistent atrial fibrillation
      • I48.19 Other persistent atrial fibrillation
    • I48.2 Chronic atrial fibrillation
      • I48.20 …… unspecified
      • I48.21 Permanent atrial fibrillation
    • I48.3 Typical atrial flutter
    • I48.4 Atypical atrial flutter
    • I48.9 Unspecified atrial fibrillation and atrial flutter
      • I48.91 Unspecified atrial fibrillation
      • I48.92 Unspecified atrial flutter
  • I49 Other cardiac arrhythmias
    • I49.0 Ventricular fibrillation and flutter
      • I49.01 Ventricular fibrillation
      • I49.02 Ventricular flutter

Bradycardia types

Sick sinus syndrome

Referred to as sinus node dysfunction, the condition can occur due to any issues with the sinus node such as – too slow heartbeat rate, and sinus arrest or heartbeat stops.

Conduction block

Also referred to as atrioventricular (AV) conduction disturbances or blocks, it can cause the signals that trigger the heartbeats to slow down, irregular or stop.

Bradycardia codes

  • I49.5 Sick sinus syndrome
  • I49.8 Other specified cardiac arrhythmias
  • I49.9 Cardiac arrhythmia, unspecified

Providers recommend adopting healthy lifestyle changes to prevent the risk for conditions such as high blood pressure and heart disease, which can lead to arrhythmia. Other treatments mainly aim at managing any underlying condition, such as an electrolyte imbalance, high blood pressure, heart disease, sleep apnea, or thyroid disease.

To ensure complete and accurate coding of the diagnosis and treatment of arrhythmia on their medical claims, practices can take support from a professional cardiology medical billing company.
Experienced cardiology medical billing companies ensure clean claims and thus help practices to collect maximum reimbursement.

What Are CPT Code Modifiers? How Are They Used?

What Are CPT Code Modifiers? How Are They Used?

Modifiers are codes that provide additional information about a procedure. They are added to CPT or HCPCS codes to communicate certain circumstances regarding the performance of a procedure or service. Appending the correct modifier to provide more specificity to payers about the service or procedure rendered will facilitate appropriate reimbursement. Likewise, an incorrectly used a medical billing modifier on a claim will lead to denials. Experienced providers of medical billing and medical coding services can help practices file clean claims by assigning the correct codes and modifiers to support the services rendered.

Types of Medical Coding Modifiers

As we know, CPT codes are five-digit numbers and primarily used in office and outpatient settings to report medical procedures and services in claims submitted to insurance companies. These codes are assigned based on the physician’s documentation in the medical record. Modifiers provide a way to convey specific circumstances related to the performance of a procedure or service.

The two broad types of modifiers used in medical billing are:

  • Level I Modifiers – Level I CPT modifiers consist of two digits and are maintained by the American Medical Association (AMA).
  • Level II Modifiers – Level II modifiers or HCPCS modifiers are alphanumeric or have two letters and maintained by the Centre for Medicare & Medicaid Services (CMS)

Specifically, a modifier provides the mechanism to:

  • Report or indicate that a service or procedure has been performed and altered by some specific circumstance without changing the meaning of the CPT code.
  • Provide additional information about the service that has been performed more than one time or services that have occurred unusually.
  • Provide details not included in the code descriptor
  • To report codes in connection with specific payer programs

CPT lists additional situations when a modifier may be appropriate:

  • The service or procedure has both professional and technical components
  • More than one provider performed the service or procedure
  • More than one location was involved
  • A service or procedure was increased or reduced in comparison to what the code typically requires
  • The procedure was bilateral
  • The service or procedure was provided to the patient more than once

Commonly Used CPT Code Modifiers

  • CPT Modifier 22Increased Procedural Service – This modifier describes an increased workload associated with a procedure. Modifier 22 is used in unusual circumstances such as surgeries that took significantly more time than usually required to complete, which includes increased intensity, time, technical difficulty of procedure, severity of patient’s condition (such as unusual or excessive bleeding during a procedure).
  • CPT Modifier 25 Significant, Separately Identifiable Service – Modifier 25 is applied when there is a significant, separately identifiable evaluation and management (E/M) service done by the same physician or other qualified health care professional on the same day of the procedure or other service. It is used to report surgical procedures, labs, X-rays, and supply codes that are documented as a separately identified E&M service performed on the same day as another procedure. If the patient presents to the office and a procedure was not anticipated, modifier 25 can be reported with the E&M service.
  • Modifier 26 Professional Service – Modifier 26 indicates the professional component when a service has both professional & technical components. For e.g., in radiology services, the physician’s note on the scans is considered as the professional component while the machinery used is counted as a technical component. The professional component may include technician supervision, interpretation of results, and a written report. Append modifier 26 for the following:

    • To bill only the professional component portion of a test when the provider utilizes equipment owned by a hospital/facility.
    • To report the physician’s interpretation of a test, which is separate, distinct, written, and signed.
  • Modifier 50 Bilateral Procedure – Modifier 50 indicates that bilateral procedures were performed in the same session. For e.g., when billing for a bilateral mastectomy, CPT code 19303 (Mastectomy, simple, complete) would be reported with this modifier. Before applying this modifier, it is important to check the CPT code definition to confirm that bilateral is not included in its descriptor.
  • Modifier 51 Multiple Procedures-Modifier 51 is used to denote multiple procedures (other than E/M services) performed by the same physician during the same session. Modifier 59 is used to indicate:

    • Additional or different procedures performed at same session
    • Same procedure performed multiple times at same site
    • Same procedure performed multiple times at different sites

    The primary procedure may be reported first without the modifier. Additional procedure(s) may be identified by attaching modifier 51 to the code(s).

  • Modifier 52 Reduced Services – Modifier 52 indicates that the physician has elected to partially reduce or eliminate the service or procedure. The basic service described by the CPT code has been performed, but not all aspects of the service have been completed. When a physician performs a bilateral procedure on one side only, append modifier -52. For e.g., if a physician performs a unilateral tonsillectomy on a six-year old child, report CPT code 42820) and append modifier 52.However, if the CPT code description includes “unilateral or bilateral,” (e.g. unilateral nasal endoscopy CPT code 31231) do not append modifier 52.
  • Modifier 59 Distinct Procedural Service – This modifier indicates that a procedure is separate and distinct from another procedure on the same date of service. It identifies procedures or services that are not usually reported together. Indications for the use of modifier 59 are:

    • Different session or encounter on the same date of service
    • Different procedure distinct from the first procedure
    • Different anatomic site
    • Separate incision, excision, injury or body part

    Both modifier 52 and 59 should not be applied to an E/M service.

  • Modifier 76 – Modifier 76 is used to report repeat procedure performed on the same day by the same physician and is also consequent to the original procedure. For instance, CPT code 94640 signifies treatment of acute airway obstruction with inhaled medication and/or the use of an inhalation treatment to induce sputum for diagnostic purposes. If more than one inhalation treatment is performed on the same date of service, code 94640 should be reported by appending modifier 76.

Ensure Accurate Medical Billing and Coding with Professional Support

The AMA publishes CPT coding guidelines each year on coding specific procedures and services. Proper use of modifiers is crucial for accurate coding and also because many modifiers impact providers’ reimbursement. Not using a modifier or using the wrong modifier can result in claim denials and lead to rework, payment delays, and potential reimbursement loss. Incorrect use of a modifier can also result in excess of the amount payable for a service rendered or receiving payment when payment is not due, which if not reported by the practice, can lead to heavy fines and penalties.

Getting professional support can go a long way in ensuring that the billing and coding cycle runs smoothly. Top medical billing companies have expert coders who are knowledgeable about CPT codes and modifiers and can help physicians report their services with the utmost specificity. They will ensure that modifier codes are reported only when they are relevant and supported by specific documentation in the patient’s medical record.

December 3 Is International Day of Persons with Disabilities – ‘Fighting For Rights in the Post-COVID Era.”

December 3 Is International Day of Persons with Disabilities – ‘Fighting For Rights in the Post-COVID Era.”

Since 1992, the International Day of People with Disabilities (IDPwD) is being observed by the United Nations (UN) on December 3 every year. The theme for 2021 IDPwD is “Fighting for rights in the post-COVID era.” Documentation of disability is an important requirement for disabled persons to receive the disability compensation they are eligible for. Physicians providing treatment for disabilities can rely on experienced companies that provide medical coding services to meet their documentation requirements, including medical billing and coding, for claims submission. Such companies provide the service of medical coders trained in using the current medical codes to report covered disabilities and the treatments provided.

ICD-10 Codes for Different Types of Disabilities
ICD-10 Codes for Different Types of Disabilities

UN statistics show that of the 7 billion worldwide population, more than 1 billion live with some disability or other. 80% of the disabled live in developing countries. This one billion people living with disabilities worldwide face many obstacles to inclusion in some key aspects of society. For instance, they do not enjoy access on an equal basis as others in various areas such as transportation, employment and even social participation such as politics or entertainment. However, since its inception in 1945, the UN has honed its focus on promoting the well-being of people living with disabilities, and their efforts culminated in instituting the IDPwD observance day.

IDPwD is observed with the aim of promoting empowerment, and helping to create real opportunities for people with disabilities. It enhances the disabled person’s own capabilities and supports them in laying their own priorities. By empowering people with disabilities (that is, by investing people in jobs, health, nutrition, education, and social protection), they are better prepared to take advantage of opportunities; they become factors of change and can more readily embrace their civic responsibilities.

This year, IDPWD can be celebrated with the challenges, barriers and opportunities for people who live with disabilities, in the context of a global pandemic. That is, since 2020, each and every person in this world has been impacted – politically, socially and economically – by the pandemic, COVID-19. During this disability day observance, we should recognize that people who live with disabilities are among the most affected populations amid the COVID pandemic. Along with marginalization, discrimination, vulnerability and exploitation – which are every day struggling factors for many people – the increased risk of poor outcomes due to the pandemic have been exaggerated with the reduced access to routine healthcare and rehabilitation services. The pandemic also causes social isolation, poorly tailored public health messaging, inadequately constructed mental health services, and a lack of emergency preparedness for people with special needs.

So, on this special day, let’s learn from the experiences of people living with disabilities during this pandemic and move forward for more significant investments into the socio-economic building blocks so as to reduce the barriers faced by disabled people in the global community.

Top 10 ICD-10 Codes For Thanksgiving

Top 10 ICD-10 Codes For Thanksgiving

As you know, Thanksgiving holiday celebrates the giving of thanks for the autumn harvest. Every year, Thanksgiving falls on the fourth Thursday of November. This year, the day is on Thursday, November 25. This is the time for delicious foods, get-togethers and parties with family and friends, and backyard football games. But there’s also a greater risk of injuries from such activities. Thanksgiving poses injury risks from car accidents, house fires, cooking burns and cuts, slip-and-falls, and heart attacks. Often, people rely on emergency rooms to get urgent care for such concerns. Busy medical practices can consider medical coding outsourcing to submit error-free medical claims to insurers, on time.


ICD-10 Codes for Common Thanksgiving Related Injuries

  1. Food poisoning
    • A05.0 Foodborne staphylococcal intoxication

    Consumption of left-over food could cause issues, as it will grow bacteria even after reheating. There are increased chances that the food might not get properly cooked in the first place. Practicing safe steps in food handling, cooking, and storage helps prevent food-borne illnesses. USDA Food Safety guidelines recommend discarding any food left out at room temperature for more than 2 hours (1 hour if the temperature was above 90 °F).

  2. Overexertion
    • X50 Overexertion and strenuous or repetitive movements

    Too much physical activities during such a festive occasion can cause overexertion inflammation, leading to pain and discomfort. Overexertion injuries most commonly affect the neck and back, often contributing to chronic pain in the upper and lower back. Taking frequent breaks during games and drinking plenty of water can help avoid overexertion.

  3. Fire and burns
    • X10 Contact with hot drinks, food, fats and cooking oils

    Burns are bound to happen, when cooking without proper precautions. Pay close attention when cooking turkey and other food. Never leave ovens and stoves unattended. Having a fire extinguisher handy can restrain the flames before they get out of control. Never keep flammable items near the stove or oven. When deep frying, turkey – wet or partially frozen – can catch fire or even explode, causing burns. Too many cooks in the kitchen can also contribute to accidental burns.

  4. Car accidents
    • V89 Motor- or nonmotor-vehicle accident, type of vehicle unspecified

    Drunken driving accidents peak during the Thanksgiving holiday season. Alcohol consumption is common during holidays and is a major contributing factor to motor-vehicle crashes. Some even travel to more than one place to enjoy multiple meals. Alcohol-impaired driving can lead to crashes and injuries. It is ideal to avoid high traffic times, if possible and avoid driving, if drunk.

  5. Sports injuries
    • W21.01 Struck by football

    Most families enjoy playing a little backyard football during this day. Such sports can also lead to knee injuries, ankle or finger injuries, sprains and strains, hand and finger fracture. Often orthopedic doctors recommend sports rehabilitation programs to help recover from such sports injuries.

  6. Carving Injuries
    • W29.1 Contact with electric knife

    Cuts from carving turkeys are a common injury on Thanksgiving Day. Carving turkey using electric or other knife requires caution. Any distractions can lead to injuries or finger laceration. Keeping the cutting surface dry will prevent the bird from slipping while chopping. Using a sharp knife carefully can prevent most accidents.

  7. Slip and Fall Injuries
    • W01 Fall on same level from slipping, tripping and stumbling

    Slips and falls can occur, if there are more people in the home than usual or with more activities in the kitchen. Slips and falls can lead to fractures, concussion, spinal injuries, knee injuries or more.

  8. Injuries at a shopping mall
    • Y92.513 Shop (commercial) as the place of occurrence of the external cause

    There will be more shoppers in malls to compete with than ever to grab more offers. Slip and fall accidents are common at stores due to spills, uneven floor surfaces, poor lighting, or failure to maintain the space. To prevent injuries at stores, measures must be in place to quickly attend to spills and lessen the amount of crowded spaces.

  9. Heartburn and indigestion
    • R12 Heartburn

    Overeating certain foods or drinks with a high amount of spice, acid or caffeine can cause heartburn or indigestion. To enjoy the holiday meal and to prevent heartburn or other digestion issues, consider eating smaller and more frequent meals.

  10. Heart attacks and strokes
    • G46.3 Brain stem stroke syndrome

    Rich meals and drinking too much alcohol during the Thanksgiving holidays along with stress during travelling and cold temperatures can lead to many health issues. Any strain on the blood vessels can cause the blood pressure to rise, which could contribute to heart issues.

Taking certain precautions can reduce the risks of these incidents to a great extent. To get reimbursement on time, providers can depend on companies providing reliable medical coding services. Professional outsourcing companies will be prepared to help providers report the right diagnosis codes on their medical claims.