Forum - Questions & Answers

Jan 19th, 2015 - cskinner13k4

Claim Denial using Trunk CPT® and Shoulder ICD-9

My claim is being denied for using CPT® code 13101 and 11404 with diagnosis code 216.5. I always considered the shoulder to be part of the trunk. Please let me know if this is correct coding or if I should be using the CPT® codes for arm. Thank you

Jan 21st, 2015 - Jackfraust 69 

re: Claim Denial using Trunk CPT® and Shoulder ICD-9

I am taking a ICD-10-CM course and asked the instructors about this question and they said shoulder was considered part of the arm for CPT® codes

Good question

Jan 21st, 2015 - jvosfernea 66 

re: Claim Denial using Trunk CPT® and Shoulder ICD-9

It might also depend on whether billing OT or PT codes - where the general delineation is typically the Acromium Process: if the muscle/procedure is at or above the acromial process, then the area in question is considered the shoulder/trunk; if below (and not crossing over) then is considered shoulder/ARM? so, sometimes depends on the structure on which the service is provided.



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