Wiki Coding Comorbid Conditions

[staceyhibbert@gmail.com]

I work in physician coding for specialty practices (Neurology, Rheumatology, etc.). I’ve only been coding for about 6 months now and a few days ago we were discussing comorbid conditions and when to code/not code them. Does anyone have any insight for me or documented instructions when to code comorbid conditions in ICD-10 coding? I’m specifically looking for whether or not the physician has to actually addresss the conditions or if they can be taken from the HPI or past medical history, etc., and coded after the primary/secondary diagnoses? Thanks for your help!

 

[johnpiaskowski]

Comorbid conditions

From a billing standpoint, if the conditions are impacting the medical decision making of the evaluation, then code any comorbid conditions. Please note the difference between signs/symptoms and comorbid conditions. A comorbid condition is a condition that affects the patient concurrently without necessarily being the cause of the treated condition (but may. ie diabetes, CKD, genetic disorder) A sign and symptom is a direct result of the condition being treated. ie cough, headache, anemia.. Never code signs and symptoms of the condition being treated. This is a good way to better define to the payor the level of service billed.

From a Medicare standpoint, you should code all chronic conditions (especially if they have the HCC designation after them in the ICD10CM book) regardless if they impact the medical decision making or not. This is the core of Risk Adjustment Coding and is actually a key component of the diagnosis code selection section of the ICD10CM manual.

-John Piaskowski CPC CPMA CRC CCC CGSC

 

[johnpiaskowski]

Comorbid conditions

...as per taking comorbid conditions from the HPI, it is permissible as long as it is confirmed objectively in the documentation by the physician. As for the past medical history, I do not advise you to code from past medical history unless they are confirmed as current by the physician. We are not clinicians and cannot assume current status of illness. If you are unsure, ask the physician to clarify. Sometimes medication recently administered/prescribed can be a hint of condition status, just ask the provider to add an addendum to the record if he/she confirms a condition as current. Again, it not recommended to assume.

 

[staceyhibbert@gmail.com]

Thank you for your reply! I spent 17 years as a medical transcriptionist prior to obtaining my coding certification and I've worked in a medical field of some sort for the past 20 plus years. I feel I have a fairly good understanding of comorbid conditions. However, a couple of my providers (neurologists) recently had an official audit done and I received some feedback on my work as well. It was brought to my attention that I should not code comorbid conditions unless the physician specifically addresses them. With quite a few neurology patients following up for a recent stroke or a past history of a stroke/CVA/TIA, when the past medical history or HPI mentions hypertension or hyperlipidemia and/or the social history mentions the patient is a current smoker, yet the neurologist doesn't directly address these issues, I'm finding it hard to not code these conditions as I feel they do have an impact on the patient's care and the provider's MDM.

I also code for our wound clinic physicians and I'm running into comorbidities such as diabetes and smoking, but when the patient has a non-healing wound that isn't due to their diabetes, I'm supposed to leave the fact that they're a diabetic off the list of codes I use? With diabetes being a potential cause for a slow healing wound, I'm having trouble wrapping my head around why I shouldn't code it, as well as the negative effect smoking can have on diabetic wound healing, just because the physician doesn't directly address it, but does document that the patient has diabetes and is a smoker.

Any insight you have that may help me understand the thought process of leaving these issues out would be greatly appreciated. I like for things to make sense!