Question Healthcare Business Monlty Sept 2019: Assess Documentation to Validate Risk Adjustment Coding

lrupple

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Criterion of "depression episode" and "DSM" is referenced in this article for supporting conditions. We encourage best practice documentation always but my question is where in the ICD10 guidelines does it state for depression requires "episode of care" and for dependence "DSM" is required? I am asking more as a reference to support the use of these standards. Currently in the ICD10 guidelines Section I, A, 19 it states: The assignment of a diagnosis code is based on the provider's diagnostic statement that the condition exists. The provider's statement that the patient has a particular condition is sufficient. Code assignment is not based on clinical criteria used by the provider to establish the diagnosis.

Was this article referring to pulling conditions out of the record for submission if they were not listed as current conditions under A/P? Thank you.
 
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I looked up that article. It looks like it was rejected because all that was documented was "major depression". There was no documentation as to whether it was mild, moderate, or severe and also whether it was a single episode or recurrent. Especially if there are no meds listed, they probably want to know why. Is it current or is it now in remission?
 
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