Internal Medicine Coding Alert
ICD-9: You Should Claim Primary Reason as D1
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Question: Should I first report the original diagnosis or the manifestation?
North Carolina Subscriber
Answer: You should report the complication first followed by the background. Prioritize the diagnoses in order of descending order of importance, starting with the one that receives the most attention at the visit.
For instance, a patient with an upper respiratory infection (URI) develops chest pain from coughing. So, the family physician sends the patient to a radiologist for a chest x-ray. The radiologist interprets the results as normal. In this case, you should report the symptom, chest pain (786.50, Chest pain, unspecified), which prompted the chest x-ray, in the first position (diagnosis 1, D1) on the claim form.
List the initial cause, the URI (465.9, Acute upper respiratory infections of multiple or unspecified sites; unspecified site), in the second position. Reversing the order and reporting URI in the first position may trigger a denial. Code 465.9 doesn't prove the medical necessity for a chest x-ray, but 786.50 clearly tells the payer why the FP ordered the test.
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