ICD 10 sequencing


Orlando, FL
Best answers
I was under the impression that only those diagnoses that were addressed at this visit should be included on the claim, unless certain chronic conditions/comorbidities are impacting or related those issues that are being addressed this visit. In the aftermath of the ICD 10 transition I have been running into claims where the physician/clinician and/or coder lists every diagnosis in the chart on every claim. For instance, a patient on CPAP with OSA sees a nephrologist for Stage 3 CKD. The patient is established with this nephrologist who is managing her CKD. Nothing was addressed for the OSA on CPAP (except to mention that she has the condition) during this visit. The patient also has hyperlipidemia, hypothyroidism and Vit D deficiency, but the only thing addressed for the visit was medication management for NSAID's and CKD related scripts. The nephrologist submitted the following codes for the 99214 billed:

N18.9(CKD), G47.33(OSA on CPAP), E03.9 (hypothyroid), E78.2 (HLD) and E55.9 (Vit D).

IMO, since only the CKD was addressed, only the CKD should be submitted on the claim. If the patient had associated comorbidities, I know those would be included, but I don't see it stated and the etiology does not suggest that the other conditions are associated with CKD.

This pertains to pro fee billing in an office. location code 11.

Any other opinions?
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