ED Coding and Reimbursement Alert

Question: Can I report signs and symptoms as diagnoses?


Florida Subscriber


Answer: Multiple sources, including both Medicare and the ICD-9 coding guidelines, instruct that using signs and symptoms is appropriate in the emergency department. If the physician ultimately designates a diagnosis, you should report that diagnosis as well as the signs or symptoms that prompted the patient's treatment in the ED. The key word in that sentence is -if---because if the ED physician doesn't confirm a diagnosis, you might report only the signs and symptoms. 

For instance, suppose a painter falls from a ladder and presents in the ED with complaints of wrist pain. The physician documents that the patient has pain on range of motion and tenderness over the anatomic snuffbox, but normal x-rays. The physician documents a diagnosis of -rule out scaphoid fracture.-

ICD-9 coding guidelines state that you should not report -rule-out- diagnoses in the outpatient setting. You still definitely have the wrist pain as a sign or symptom, however--which you should report as the diagnosis, because no more definitive diagnosis exists. 

In addition to the primary diagnosis 719.43 (Pain in joint; forearm), you should also assign E881.0 (Fall on or from ladders or scaffolding; fall from ladder) as a secondary diagnosis to describe how the injury occurred.