Coding Order Confusion

[Radcoder86]

I'm really confused on what order I'm supposed to be putting the order of dx codes in when the provider states due to or secondary to. Is this considered a comparative or contrasting condition, or should it be treated like a manifestation codes? I'm supposed to be putting in the diagnoses that are causing the confirmed diagnosis right...and if so, what order? My brain is mush.

 

[BenCrocker]

Code First the Definitive DX, then any secondary codes, then any external causes.
If there's no definitive DX then you code signs and symptoms.

That's putting it very simply.

 

[emcee101]

"due to" or "secondary to" creates a casual relationship in the documentation to show that one condition is a direct results of another condition. Refer to ICD-9 guideline I.A.6 for etiology/manifestation convention. In cases where you have an etiology and manifestation (i.e. Diabetes with diabetic retinopathy) and a relationship has been established using linking verbiage such as "due to", "secondary to", "associated with" etc., you should always code the underlying condition (diabetes with ophth. manifestations 250.50) first and the manifestation (retinopathy 362.01) second, even if the main reason for the services provided is the manifestation.

There are times when there are not dedicated etiology/manifestation codes to show that two conditions are linked even when it is documented, such as urinary retention (788.20) secondary to prostate cancer (185), but you should still code the underlying conditon first and the manifestation second when a casual relationship has been established in the provider's documentation.

 

[Radcoder86]

Okay, I've been following the manifestation rule, but then I started second guessing myself and the more research I tried doing, the more confused I got. Thank you so much!