Wiki Either/or, versus

[solocoder]

Can someone clarify, please? According to Section II, part D, when two or more contrasting or comparative diagnoses are documented as either/or (or similar terminology) they are coded as if the diagnoses were confirmed....
Does this apply to both inpatient and outpatient coding?

 

[Pam Warren]

Section II begins: "the circumstances of inpatient admission".....

 

[mitchellde]

Also please note that inpatient guidelines apply to the facility coder, not the coder for physician reimbursement

 

[solocoder]

Thank you for your replies. I did actually see "the circumstances of inpatient admission"..... at the beginning of Section II, but just wasn't sure if I should interpret that to mean everything in Section II applies to inpatient only. Sounds like that is the case?

 

[Munzueta]

Section II and Section III are inpatient guidelines, so it won't apply to outpatient coders (coders using CPT and HCPCS to code for services)

One of the main differences of outpatient and inpatient coding guidelines is that outpatient coders will not code suspected, probable, possible conditions, but inpatient coders will.

hope this clarifies your question.