Wiki Hyperlipidemia dx coding

[ajkerr]

If a provider has Hyperlipidemia listed in the HPI and states they are on statins but under their A/P they have Pure Hypercholestermia (E78.00) controlled on statins is it correct to code the E78.00 or should you code Hyperlipidemia unspecified E78.5? I’m having trouble finding guidelines on this. My auditor recently stated that since it only states Hyperlipidemia in the HPI I should only code E78.5 and not the E78.00 that’s listed in the A/P. I disagree with that in my mind the E78.00 is more specific than the E78.5 and we are supposed to code to the greatest specificity that we can. Any help with this would be greatly appreciated.

 

[thomas7331]

Generally I would code from the assessment and not from the HPI. The assessment should reflect what the provider has determined the correct diagnosis for the patient is at that encounter, whereas the HPI is usually taken from the patient's own words, or a history from a different provider, which may or may not agree with what the provider ultimately decides. I'm not sure why your auditor would give priority to the HPI - that does not sound correct to me.

Now, if the provider has simply selected the incorrect code by choosing H78.00 and does not understand that unspecified hyperlipidemia should be coded as E78.5, then that's a different issue. You may need to query your provider in a case like this to understand if they really meant hypercholesterolemia, and/or educate your provider as to which condition is coded which way if the documentation isn't clear as to what they are intending as their final diagnosis. The codes used should always reflect the provider's verbal statements, not the provider's code choices.