Wiki Can "presumed" diagnoses be coded?

ca_cpc

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I'm about to have yet ANOTHER conversation with my providers about coding suspected diagnoses (and how they need to stop doing it), and I want to make sure I'm giving them all of the correct information on terminology.

I've been debating whether "presumed" diagnoses can be coded. Obviously, things like suspected/probable/question of can NOT (no matter what my providers think 😑), but "presumed" isn't specified in the guidelines and, in my opinion, offers more certainty than "suspected." The way I'm looking at it, "presumed" more implies a clinical diagnosis, wherein the provider is going to treat the condition as such but does not have diagnostic results to "prove" their case. I am inclined to code them, but I've always had that small doubt in the back of my mind. (Fortunately, this doesn't come up too often.) What are other coders' opinions and practices?

Thank you!
 
I'm about to have yet ANOTHER conversation with my providers about coding suspected diagnoses (and how they need to stop doing it), and I want to make sure I'm giving them all of the correct information on terminology.

I've been debating whether "presumed" diagnoses can be coded. Obviously, things like suspected/probable/question of can NOT (no matter what my providers think 😑), but "presumed" isn't specified in the guidelines and, in my opinion, offers more certainty than "suspected." The way I'm looking at it, "presumed" more implies a clinical diagnosis, wherein the provider is going to treat the condition as such but does not have diagnostic results to "prove" their case. I am inclined to code them, but I've always had that small doubt in the back of my mind. (Fortunately, this doesn't come up too often.) What are other coders' opinions and practices?

Thank you!


The ICD-10 guidelines very clearly state that "probable" diagnoses cannot be coded for outpatient services. Presumed would fall under that too - whatever is being "presumed" would not be the highest degree of certainty known, and the symptoms/signs should be coded instead.

Section IV. Diagnostic Coding and Reporting Guidelines for Outpatient Services

H. Uncertain diagnosis Do not code diagnoses documented as “probable”, “suspected,” “questionable,” “rule out,” “compatible with,” “consistent with,” or “working diagnosis” or other similar terms indicating uncertainty. Rather, code the condition(s) to the highest degree of certainty for that encounter/visit, such as symptoms, signs, abnormal test results, or other reason for the visit.
 
I really have no idea why they just don't add the word "presumed" into the portion of the guideline I snipped above, then it would take away any argument & eliminate any perceived grey areas.

(Even though I think it's still clear because something that is presumed still isn't certain.)
 
Thanks! I will absolutely defer to the majority interpretation here. I could rattle off a defense of why I do see grey, but it's really moot; there is a reason I asked and I will take the answer! I'm just glad I did ask for other opinions before waffling when I want to sound confident during a stern lecture at my providers. (Maybe this time they'll actually listen?) Thanks again; I appreciate the input from both of you.
 
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