ED Coding and Reimbursement Alert

Don't let signs and symptoms throw you for a loop

You-re never surprised when the doctor lists conditions in the chart that aren't final diagnoses, but when those conditions add crucial information about the reason for the patient's presentation, they may be critical to getting your claim paid. Use these five key concepts to determine when to include the information and when to chuck it. 1. Use Signs and Symptoms to Pinch Hit When the physician hasn't stated a final diagnosis, you still need to explain why the patient came to the emergency department.

In such cases, reporting signs and symptoms as the reason for the encounter is appropriate, says Karen Marsh, RN, MSN, president of Kare-Med Consulting in Jensen Beach, Fla. -Many times you-ll see that the physician will only give us a symptom as a diagnosis because of inconclusive lab tests or radiology reports, or future testing that needs to be done,- she says. 2. Don't Shy Away From V Codes Coders are often hesitant to report V codes, but sometimes they are the most accurate descriptors of the reason for the patient's trip to the ED. According to the ICD-9-CM Official Guidelines for Coding and Reporting (published on CMS- Web site in April 2005), codes V01.0 (Cholera) through V84.8 (Genetic susceptibility to other disease) are appropriate codes to identify diagnoses, signs, symptoms, conditions, problems, complaints, and other possible reasons for the ED encounter.

-It sounds like a simple, straightforward concept, but over the years it hasn't been clearly defined in the emergency department, and at times, we have been reluctant to report such conditions as symptoms or related conditions on ED claims,- Marsh says. -This document gives us supporting evidence that reporting symptoms is the appropriate thing to do.-

Remember that listing a V code as the primary diagnosis on the claim may cause some reimbursement issues, says Michael A. Granovsky, MD, CPC, FACEP, vice president of MRSI, an ED coding and billing company in Stoneham, Mass. When appropriate, you should place the V code in the secondary position and use a stronger sign or symptom code as the primary diagnosis, he says.

3. Separate Dx Code From Its Kin If the ED physician has assigned a final diagnosis, don't report extra codes for signs and symptoms that are integral to that diagnosis. For instance, if the physician lists a final diagnosis of -acute asthma- (493.2x), you don't need to report -wheezing- (786.07) as well, because wheezing is a symptom of asthma.

Additional signs and symptoms that aren't related to the final diagnosis are fair game, however. For example, if the physician's final diagnosis is -lacerated finger- (883.0), but he also documents that the patient has a fever, you can report [...]