Wiki Diagnosis code billing

[s7mich@hotmail.com]

When billing and E/M code to an insurance company, do we only bill for the diagnosis we are treating? I have been told different things. I need to know if the patient has co-morbities does that get reported as well to the insurance company when billing out the evaluation code or just the treating problem. Any thoughts on this would be greatly appreciated.
Thank You

 

[thomas7331]

The definitive answer for this is located in the 'coding guidelines' section at the very beginning of your ICD-9 or ICD-10 book. For outpatient services, the official guideline is to "code all documented conditions that coexist at the time of the encounter/visit, and require or affect patient care treatment or management. Do not code conditions that were previously treated and no longer exist.... However, history codes... may be used as secondary codes if the historical condition or family history has an impact concurrent care or influences treatment." So you should only report those conditions that the provider documents were a factor in the treatment being provided.