confused

Ms.M

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Hi,

I would like to know if coding for a physicians office.

example:
Body of report states "pancreatitis"

Impression states : probable pancreatitis.

Would you code the pancreatitis? Or would you just use 577.8?


Thank you,
 
clarity needed

Hi,

I would like to know if coding for a physicians office.

example:
Body of report states "pancreatitis"

Impression states : probable pancreatitis.

Would you code the pancreatitis? Or would you just use 577.8?


Thank you,

I would definately get some clarification from the physician... you do not want to code "probable, rule out or questionable for outpatient coding.... if no definate dx is listed or given once you querry the doc, you would need to go with signs & symptoms...
 
re; confused

Hi,

Well the company I worked for said to just code the pancreatitis.
That we can go by the body of the report.
 
I'm the coder for a surgical office and I never code a "rule out". If that is all I have as to the reason why of physician saw the patient I would query the physician as to what exactly he felt their diagnosis was and request that he write that on his dictation (as a correction) or on the hospital note if the patient was seen in the hospital. But that could be just me.....
 
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