Wiki Diagnosis coding for outpatient professional services

[donnagullikson]

I have one coder who's consistently coding all relevant diagnosis on patients when there's a final diagnosis. For example, patient comes in for lower right extremity pain/edema, hx of smoking, diabetic with a final diagnosis of PAD. She codes the PAD first then the pain/edema, smoking history and diabetic. I"m coding only the PAD, history of smoking and diabetes and told her that symptoms of PAD includes pain and edema and that pain and edema doesn't need to be coded. I'm I telling her correctly because she recently went to a coding seminar and was told the more we give the insurance companies the more likely we're to get paid? I''m thinking they meant give them more of the high risk codes...such as smoking, being diabetic, hyperlipidemia etc......

Thanks,

 

[CodingKing]

ICD-10-CM guideline IV.J

Code all documented conditions that coexist

Code all documented conditions that coexist at the time of the encounter/visit, andrequire or affect patient care treatment or management. Do not code conditions thatwere previously treated and no longer exist. However, history codes (categories Z80-Z87) may be used as secondary codes if the historical condition or family history hasan impact on current care or influences treatment.

Although it must be documented in the visit record. You cannot just go grab diagnosis codes from previous encounters. Each encounter must be able to stand alone.

 

[Sovacool]

I have one coder who's consistently coding all relevant diagnosis on patients when there's a final diagnosis. For example, patient comes in for lower right extremity pain/edema, hx of smoking, diabetic with a final diagnosis of PAD. She codes the PAD first then the pain/edema, smoking history and diabetic. I"m coding only the PAD, history of smoking and diabetes and told her that symptoms of PAD includes pain and edema and that pain and edema doesn't need to be coded. I'm I telling her correctly because she recently went to a coding seminar and was told the more we give the insurance companies the more likely we're to get paid? I''m thinking they meant give them more of the high risk codes...such as smoking, being diabetic, hyperlipidemia etc......

Thanks,

icd10 guidelines chapter B section 5

Conditions that are an integral part of a disease process

S/s that are associated routinely with a disease process should not be assigned as additional codes, unless otherwise instructed by the classifications. In this example it's wrong to code the pain/edema. I would need to see the note for determine if I would code the DM.

Kate Sovacool CPMA,CPPM,CPC