Correct coding

darmentd

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Hi ....

I have been a CPC since 1999 and when I was trained I was taught you get your codes from the final results unless the result is negative.
For example - a patient comes in with back pain and the report finidings are Lumbar DJD you code Lumbar DJD. If the patient was negative you code for the the back pain.

I am now being told by administration we no longer need to read reports for outpatients and are to solely code from the patients signs and symptoms, with the exception of medicare which we have to read and code to the highest specificity.
How can I feel comfortable doing this ?
What if a patient has abdominal pain and the report shows appendicits and I didnt put that becaue I was told not to read reports anymore ...unless they are medicare ? Isnt that favoritism ?


No my old brain doesnt serve me as well as it should but Im pretty sure this is wrong, I think I remember there was some ruling that all patients need to be treated equally and secondarily coding needs to be done from the end result.
Im hoping there is someone who can site some legal information for me to help me....this just cant be right.

Thanks you
Debbie Darmento, CPC
ddarmento@glensfallshosp.org
 

Treetoad

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I was taught to code sign & symptoms only if no other diagnosis was available. If there are path/lab results, x-ray findings, or if the provider is giving me a definite diagnosis (not questionable, rule out, etc...) I use that.
 

darmentd

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I was taught to code sign & symptoms only if no other diagnosis was available. If there are path/lab results, x-ray findings, or if the provider is giving me a definite diagnosis (not questionable, rule out, etc...) I use that.
Yes IF there was no other diagnosis available BUT we have computerized results and the end result is ALWAYS available (if there is one). We are being told that there is no reason to look at the anymore as it is appropriate to code directly from signs & symptoms for all patients EXCEPT medicare.
 

darmentd

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Perhaps I should have mentioned this is in regards to radiological procedures and all the results are always available at the time we get the order sheets with the visit number we code from....sorry !
 

LaSeille

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correct diagnosis coding

See the "official coding guidelines" in your ICD-9 coding book. On page 4, under B (general coding guidelines), #6 states "Signs & symptoms: Codes that describe symptoms & signs, as opposed to diagnosis, are acceptable for reporting purposes when a related definitive diagnosis has not been established/confirmed by the provider." That should help you prove your point to your administrators.

And...I commend you for standing up to correct coding procedures!!

LaSeille Willard, CPC
 

darmentd

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See the "official coding guidelines" in your ICD-9 coding book. On page 4, under B (general coding guidelines), #6 states "Signs & symptoms: Codes that describe symptoms & signs, as opposed to diagnosis, are acceptable for reporting purposes when a related definitive diagnosis has not been established/confirmed by the provider." That should help you prove your point to your administrators.

And...I commend you for standing up to correct coding procedures!!

LaSeille Willard, CPC
WHat ICD-9 book do you use ? We no longer get books as we now have this "wonderful" online codebook (which stinks !!)
I have an older one from Ingenix.
Thank you I appreciate your help very much !
 

Chanda

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Fraud

Hello,

I truly think this is fraudulent activity. You are suppose to code to the highest specificity, regardless of whose the carrier. If an audit should occur, whose going to take the responsibility of the relentless coding. Not your employer, you are, cause you are the coder. I'm sorry you have to go through this, cause you have much experience.:(

Chanda, CPC
 

LaSeille

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Correct Coding

WHat ICD-9 book do you use ? We no longer get books as we now have this "wonderful" online codebook (which stinks !!)
I have an older one from Ingenix.
Thank you I appreciate your help very much !
My ICD-9 book is the professional edition from MMI (Medical Management Institute). However, I'm not sure, but I would think that Ingenix would have such a statement in it. See if it has a Table of Contents in the front, and if it does, see if there is something listed as "official coding guidelines" or "general coding guidelines". I don't know anything about the online codebooks, but does the one you use have any type of "coding guidelines" on it?

LaSeille Willard, CPC
 

RBridge

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I code the professional component of radiology and am being told to look at the hospital medical record to find a payable dx even though we code from the final report. I agree that regardless of the insurance, every report needs to be coded the same way. The ICD-9 coding conventions are very explicit about what to use as the dx, as well as the Medicare Billing Manual. Several places in the Medicare manual say that you cannot code from the hospital dx. I have always been taught that you code from the final report. It is not up to the coder to determine medical necessity. Any thoughts would be appreciated.
 

Anna Weaver

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correct coding

A.
Codes for symptoms, signs, and ill-defined conditions
Codes for symptoms, signs, and ill-defined conditions from Chapter 16 are not to be used as principal diagnosis when a related definitive diagnosis has been established.

This is a statement from the coding guidelines. If you have a definitive diagnosis (and with outpatients, we can use radiology, pathology you should be able to pull from those). You should never treat any insurance different. That is considered Fraud!!! All must be treated equal. Why would they single out medicare for definitive diagnosis and not the insurance companies? To get better reimbursment? Sounds fishy to me. I think your administrative staff needs to talk to someone or research about fraudulent billing practices. Sorry what a hassle for you. Good luck!
 

HNISHA

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I code the professional component of radiology and am being told to look at the hospital medical record to find a payable dx even though we code from the final report. I agree that regardless of the insurance, every report needs to be coded the same way. The ICD-9 coding conventions are very explicit about what to use as the dx, as well as the Medicare Billing Manual. Several places in the Medicare manual say that you cannot code from the hospital dx. I have always been taught that you code from the final report. It is not up to the coder to determine medical necessity. Any thoughts would be appreciated.
Hi,

I totally agree with Bridge. However, I am unable to find the medicare manual regarding hospital dx. Can any one please help me in searching the location (reference) of medicare manual stating hospital dx can not be coded.

Thanks for your help in advance!
 
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