Kerri
New
I am looking for feedback on the Hx codes on a T sheet from the ER docs.... I will code the Hx Dx ( personal and family), however if there is not a HX code for that specific Dx do you just not code it or do you give it a current code?
-
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 ER T sheets and Hx codes
- Thread starter Kerri
- Start date
Mojo
Expert
We code chronic conditions and history codes if they are relevant to the encounter (treated, addressed or aid in MDM). We assign a dx in the PMH as a current code if the condition continues to be treated and affects the management of the presenting problem.
mitchellde
True Blue
If it is a problem that is no longer being treated, and is history of, then you do not code it . Do not use a current code for a past issue.
Hey, all, appreciate the input! I'm new to ER coding and finding LOTS of questions! Regarding the above info, had similar scenario. Under PFSH, DM is listed for patient, and indeed, patient med list has Glucophage listed. Patient came to ER after glucose meter gave reading of 320. Final Impression by ED doc is hyperglycemia. Patient was given IV fluids. It seems to me that if the patient is taking DM meds and uses a glucose meter, that I should code DM as the principal dx. However, as noted, the ED doc never mentions DM anywhere. Suggestions? Thanks for any ideas.