Wiki disgnosis sequencing


Hawthorne, CA
Best answers
A hospitalist sees a patient as inpatient, billed with AI modifier, Dx: 585.6, 414.01, 401.1, 250.00.
Second day Dx: 414.01,585.6, 401.1,250.00
Third day Dx: 414.01, 401.1, 585.6, 250.00
By the time he is discharged on the fourth day, all the dx arrangement has changed. Is it Correct to bill this way or all four days need to have all the diagnosis in order as the forst day?
Any input will be appreciated.

2) A physician practice bills X-Ray globally.
THen when they do chart documentation in the EMR, they count (ordered X-Ray) as 1 point under DATA, so the level goes up in the E/M
Is this Okay even though we are billing global as well as counting a point for data?
Please advise.
sequencing will depend on the documentation... HOWEVER... you cannot code a 585.x code with a 401.x code you must combine these for a 403.xx code with the 585.x code sequenced second.
where can I find the sequencing guidelines? Do you have one?

This is a billing company and they bill the hospitalist. A spreadsheet is sent to them and they just bill according to what is written on the spreadsheet. A biller told me that she was not following the spreadsheet, and that she was putting the same order(as was on the initial admit) to all her subsequent days.

I told her not to since we did not have the chart notes to determine that and we should follow what the hospital provides.

As for a combination code, the biller can not make changes to that either. What should be done in that case, and the biller may not know anything about combination codes.

Any feedback would be appreciated.
You need to look at the coding guidelines for sequencing, and for thew combination rules for the HTN and CKD, it is an invalid combination to code the 401.x with the 585.x. The coding guidelines may be found at the cdc website,
scroll down to the bottom and click on guidelines. You cannot code without the documentation this is true but there are certain things you can do with just the guidelines like combine the HTN with the CKD.