Wiki Diagnosis Sequencing

[Gator]

Years ago I learned that the order the provider lists diagnosis in the office note is not necessarily the order they will appear in on the claim. The Diagnosis that drives the visit will always be listed on the claim as diagnosis #1 even if the provider may have it listed as the 2nd or 3rd or 4th etc diagnosis. Additionally, the provider does NOT need to amend the assessment order in the note as long as the coder/biller puts the diagnosis in the correction position on the claim. Is this still the case or has it changed? For example, Pt is being seen for annual wellness (main reason for visit) and F/U of chronic conditions. Provider diagnosis/assessment order in the note 1) knee pain 2)routine physical 3) HTN 4)DM 5)hyperlipids . . .

 

[TThivierge]

Hi Gator
This is basically true what you learned. But keep in mind some dx codes per ICD10 manual directions and audit process/algorithms in the Encoder program will tell you to put another dx as first. For instance if the pt has N18 CKD and DM E11.22. Dx. E13.22 you will put this first. Or dx I50.84 End Stage Heart disease add first dx code of underlying ds. I50.2-I50.4 Or Toxic Kidney Ds. K71 then code dx first T36-T50. Or dx code M10.3 Gout due to Renal involvement then add first dx of renal disease. These coding conventions/ directions "code as first dx" or "code additional " depends on provider s documentation to guide you.
Also keep in mind the first listed dx Z codes look at blocks of Z00 to Z04. And the chemotherapy dx code Z51 and Z52 are first listed Z dx codes on the claim first.
Well I hope helped you..let me know if I did
Lady T

 

[Gator]

Yes, it helps. Thank you for your feedback. There is another coder/biller that thought the provider should change the note so Zoo.oo was 1st listed in the assessment. I disagreed that the note needed to be changed.