Pulmonology Coding Alert

Question: A patient presented with symptoms of sneezing, stuffy and runny nose, cough, and sore throat. The provider performed a physical evaluation and tested the patient for COVID-19, RSV, and the flu, all of which were negative. The provider diagnosed the patient with nasopharyngitis NOS.

Should I assign codes based on the symptoms?

Texas Subscriber

Answer: No, you won’t assign codes for the symptoms because the provider diagnosed with nasopharyngitis NOS, which is coded to J00 (Acute nasopharyngitis [common cold]). Code J00 is reserved for common cold diagnoses. The code features an Includes note that lists nasopharyngitis NOS.

If the provider didn’t document a definitive diagnosis or was awaiting the test results, then you would assign codes for the patient’s symptoms. According to the ICD-10-CM Official Guidelines, I.B.4, “Codes that describe symptoms and signs … are acceptable for reporting purposes when a relative definitive diagnosis has not been established (confirmed) by the provider.”