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Wiki Coding "Other specified" Conditions

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cathya35

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When a physician diagnostic statement includes an "other specified" diagnosis but does not include information about the specific type or cause of the condition, do you use the "other specified" code? For example, the physician's diagnosis is "other hyperlipidemia" but the specific cause or type of the hyperlipidemia is not documented. Would correct coding for this be E78.4 or E78.5? Another example is a physician diagnostic statement of "other specified diabetes mellitus." Do you consider correct coding to be E13.9 or would you code E11.9 if the specific cause or type of diabetes is not documented? I've heard other auditors say that you can only code "other specified" when the documentation supports a higher level of specificity than "unspecified" even if "other specified" is part of the physician's diagnostic statement.
 
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