Who’s Responsible for Sequencing Multiple Diagnosis Codes?
Question: When a physician makes multiple diagnoses on a patient during an encounter, is the provider responsible for sequencing the diagnoses in order of severity or is the coder? Codify Subscriber Answer: The ICD-10-CM code book doesn’t specify whose responsibility it is to sequence the codes in order of severity, and the code set doesn’t contain a specific guideline stating that multiple ICD-10-CM codes need to be reported in the order of severity. On the other hand, the ICD-10-CM Official Guidelines do instruct you as to which codes should be listed, and which ones need to be listed first when you’re reporting multiple diagnosis codes. According to Guideline IV.G, “ICD-10-CM code for the diagnosis, condition, problem, or other reason for encounter or visit,” instructs you to report the code related to the condition that is the reason for the encounter first, even if it’s not the most severe condition. You’ll then assign additional codes that “describe any coexisting conditions.” According to Guideline IV.J, “Code all documented conditions that coexist”; it then instructs you to report all documented conditions that coexist “at the time of the encounter/visit, and that require or affect patient care treatment or management.” You won’t report conditions that were previously treated or that the patient is no longer experiencing. However, patient or family history Z codes can be reported as secondary codes if the condition or family history will impact or influence treatment for the patient’s current condition. Mike Shaughnessy, BA, CPC, Production Editor, AAPC
