Coding diagnosis patient isn't being seen for

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16
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Hey everyone!!

I was hoping I could get some help on this issue. When a patient comes for a weight loss visit, some insurance do not cover since we only put the obesity diagnosis. Some of these patients have diabetes, hypertension, etc. I was wondering if I can add the E11.9 and I10 diagnosis codes even when the patient is not being treated for these chronic illnesses?

If I can, does the doctor need to make a special mention of the illnesses in the HPI? Or can I code these from the problem list/medical history in the note?

Thanks so much :)
 

csperoni

True Blue
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Selden
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You code the diagnoses being treated, or that affect the treatment. If chronic illnesses are affecting the weight loss treatment, I would recommend this be indicated by the clinician.
Especially with a shared medical record in large health systems, the problem list sometimes has 10+ items. As a coder, you should not be making the clinical determination that problems 2 & 3 impacted treatment, but problems 4 & 5 did not.

PS - Coders should not code differently just to get an insurance to pay (excluding a carrier policy such as carrier does not acknowledge consult codes and advises to use 99202-99215.) The coder's responsibility is to translate the words in the medical record into codes.
 

OpenClaims

Expert
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337
Location
Miami, FL
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If the provider has listed the diagnoses for the encounter, then you must adhere to those diagnoses, even if insurance does not cover this. You also cannot query and lead the provider. The best option here would be to code accordingly and reach out to your provider education team and let them know that this is something that the provider(s) can be educated on.
Hey everyone!!

I was hoping I could get some help on this issue. When a patient comes for a weight loss visit, some insurance do not cover since we only put the obesity diagnosis. Some of these patients have diabetes, hypertension, etc. I was wondering if I can add the E11.9 and I10 diagnosis codes even when the patient is not being treated for these chronic illnesses?

If I can, does the doctor need to make a special mention of the illnesses in the HPI? Or can I code these from the problem list/medical history in the note?

Thanks so much :)
 

Gator

Networker
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41
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Rapid City, South Dakota
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0
Related question. Years ago I learned that the order the provider lists diagnosis in the office note is not necessarily the order they will appear in on the claim. The Diagnosis that drives the visit will always be listed as diagnosis #1 even if the provider may have it listed as the 2nd or 3rd or 4th etc diagnosis. Additionally, the provider does NOT need to amend the assessment order in the note as long as the coder/biller puts the diagnosis in the correction position on the claim. Is this still the case or has it changed? For example, Pt is being seen for annual wellness and F/U of chronic conditions. Provider diagnosis order in the note 1) knee pain 2)routine physical 3) HTN 4)DM 5)hyperlipids . . .
 
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