I might be overthinking this, but I can’t wrap my brain around it to save my life. Our guidelines are crystal clear that if we have a definitive diagnosis, we are NOT to code any symptoms that are considered to be associated with the definitive diagnosis.

My issue: Payers are denying the 20610 when we use anything other than a pain diagnosis.

Example: pt has right rotator cuff tear and provider decides to give them an injection to alleviate the pain

My thoughts: the rotator cuff tear is the correct dx, but it will not pass through the edits based on the dx being inappropriate for the procedure.

Can anyone please tell me how they are handling this?