Wiki Choosing diagnosis codes for lower extremity

[vidraj]

Hello everyone,

Just need your thoughts on this scenario.
I am working on getting authorization for Lower extremity study.
It was advised to evaluate peripheral vasculature as patient has claudication, leg weakness, discoloration in both legs. Patient has an abnormal ABI, showing- severe inflow disease in both legs.

Our providers gave us the code I73.9 - Peripheral vascular disease, unspecified under assessment.

Although not documented by the provider under assessment, with the supporting HPI note, Abnormal LEAD study report,
- Can I request this authorization with specific diagnosis code I70.213 - Atherosclerosis of bilateral legs with intermittent claudication.

We get a lot of denials especially with unspecified code I73.9.
I am fairly new to educating providers. And would like to guide them to document the right way.
- What would you do?

 

[thomas7331]

I would not be comfortable assigning a diagnosis of PVD to either or both legs given the documentation you've given here because none of the language that refers to 'both legs' in the text can be used to support a PVD diagnosis code, and certainly not the more specific atherosclerosis code since that diagnosis is not mentioned anywhere. I don't believe that I70.213 would hold up in an audit.

If the I73.9 code is problematic, I would query your provider for more specificity about the diagnosis and laterality of the PVD, e.g. using a non-leading query that asks if the PVD is left, right, bilateral or unknown. I would also recommend educating them that laterality is essential for accurate coding and claims payment, and that they should avoid the use of the unspecified code unless the more specific information is simply now known at the time of the encounter.

 

[vidraj]

Thank you.

You are right - I can start with requesting them on documenting the laterality and then get into the depth, once they get back.
I did want to start somewhere, and this really helps.

Appreciate your quick response .