• If this is your first visit, be sure to check out the FAQ & read the forum rules. To view all forums, post or create a new thread, you must be an AAPC Member. If you are a member and have already registered for member area and forum access, you can log in by clicking here. If you've forgotten the password it can be reset on our sign in section by entering your registered Email Address or Username here. To start viewing messages, select the forum that you want to visit from the selection below..

Wiki Diagnosis code billing

Messages
26
Best answers
0
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
 
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.
 
Top