Wiki Coding resolved conditions

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jperkins

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Is it appropriate to code a resolved condition? Here's the situation. Pt came in for follow-up of "condition". HPI says condition was present, treated, and now appears to be resolved. There are no findings on exam. Under the impression and plan it says Dx 1-"condition"; resolved. Return to clinic yearly or if condition recurs. The physician wants to assign the ICD-10 code for the condition that is not there anymore.
 
I have the same question ---- but for pro-fee hospital visits

jperkins said:
Is it appropriate to code a resolved condition? Here's the situation. Pt came in for follow-up of "condition". HPI says condition was present, treated, and now appears to be resolved. There are no findings on exam. Under the impression and plan it says Dx 1-"condition"; resolved. Return to clinic yearly or if condition recurs. The physician wants to assign the ICD-10 code for the condition that is not there anymore.
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My providers may see patients for IP/OBS follow-up visits multiple days in a row with "diagnosis; resolved" and "patient feels much better today, no complaints" .... I personally do not find the visit appropriate to bill for. I understand why the providers would want to follow-up with the patient, to ensure their care is fully completed on a clinical level. However that doesn't mean it is billable, correct??

I love to hear some expertise and reasoning on this.

To be clear, here is an example:
Provider seen patient day 1 and 2 for abdominal pain, but then day 3 and 4 were resolved with no additional tests/findings/DX/conditions
Day 1 - Billed with Abdominal Pain (good)
Day 2 - Billed with Abdominal Pain (good)
Day 3 - Billed with ... Abdominal Pain??? ... Follow-up Z-code???
Day 4 - Billed with ... Abdominal Pain??? ... Follow-up Z-code???
....Are Z-codes even paid for pro-fee hospital visits??

I'd appreciate ANY input :)
 
I guess in this situation I would have a conversation with the provider and ask why they were continuing to see the patient after the problem was resolved. The documentation and the care plan should reflect the reason for the visits, even if it is just to continue to monitor the patient, in order to support the medical necessity of the visit. Normally when a patient's problems are resolved sufficiently, they will be discharged from the hospital, or if they are hospitalized for an unrelated problem, the consulting specialist will sign off when their own services are no longer needed and the patient's hospitalization can be managed by the attending physician. Presumably, if your provider is continuing to see the patient, then there is a reason for it but it may not be apparent in their documentation. In your example above, I would expect that this patient was not hospitalized four days just for abdominal pain, but because the patient had a particular type of pain or symptoms that were indicative of the risk of something serious enough to warrant four days of hospital care until it is completely ruled out.
 
thomas7331 said:
.... Presumably, if your provider is continuing to see the patient, then there is a reason for it but it may not be apparent in their documentation. In your example above, I would expect that this patient was not hospitalized four days just for abdominal pain, but because the patient had a particular type of pain or symptoms that were indicative of the risk of something serious enough to warrant four days of hospital care until it is completely ruled out.
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Yes Thomas, this was a consulting physician, and patient was still inpatient for reasons other than abdominal pain. I have spoken with my provider(s) regarding documentation and how I cannot (in my opinion, still unsure) code for a resolved condition, especially any additional visits after the condition has already been resolved.

Since leaving my last comment, over a month ago, I had begun billing with history of Z-codes (since I did not feel it was appropriate to bill for a resolved symptom or condition). I am currently getting paid for those services coded inpatient pro-fee with only a Z-code listed primary and no other diagnosis.... however, I'm sure we're all familiar with the understanding that "just because it got paid, doesn't mean it was right" ... And I am no newbie to insurance recoupment either :rolleyes: So I just want to be sure I am correct in this!

I'm here, hoping to gain some backup on what to advise my provider(s) who continue to see these patients with ONLY resolved issues. I understand their point of wanting to "check-up" on those patients to ensure they are still without complaint, however I'm also advising that is the point of re-consult, as the check-up without current complaint/symptom/condition would not a billable visit.

Thank you for the input, it really helps!
 
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