Hospitalist OP ICD10-CM assignment question


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I am doing the billing (99221-99239) for our hospitalist that see our patients in the hospital and am unclear when deciding the ICD-10CM codes to use... if the patient's admitting diagnosis are different than the subsequent visit diagnosis and different than the discharge diagnosis, how do I assign those dx codes when billing the cpt codes- do I use different on each day or do I use the admitting dx for the complete stay in hospital- HELP I need some guidance- is there a website that is helpful/useful when doing hospitalist billing- TIA


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Start with The Guidelines

The ICD-10-CM Official Guidelines for Coding and Reporting will provide valuable information. I encourage every coder to read through them, with a highligher in hand! ICD-10-CM and ICD-10-PCS have DIFFERENT guidelines, make sure you are following those that apply to your situation. ICD-10- CM CONVENTIONS Section I.A., is a great place to start, but Section II - Selection of Prinicipal Diagnosis will help with sequencing and coding signs and symptoms vs. definitive diagnoses.
* Medical Necessity is the foundation for coding any service... why is the provider seeing the patient. Depending on the circumstances, it can change from day-day, hr-hr.
* The circumstances of inpatient admission always govern the selection of principal diagnosis. [ UHDDS / Federal Register(Vol 50, No 147, pp 31038-40)]
The codes you select will tell the story. M.E.A.T accronym might be helpful: What did your provider Monitor, Evaluate, Address/Assess or Treat during a specific encounter? Use the index, and then the tabular sections to select the codes to the highest specificity. One AdmitDay 1 the pt may have a diagnosis of Acute Abdominal Pain, AdmitDay 2 the definitive diagnosis might have been determined - GI Bleed. AdmitDay 3 Small bowel obstruction and diverticulitis..... well you get the idea.

Hoping that you have found this helpful! Keep calm and Code on!!