Wiki Inpatient Diagnosis Coding

[lcrumble]

If a patient is seen as inpatient and has a diagnosis of diarrhea likely due to taxotere, do you code this as K52.1 or R19.7? I coded as K52.1 along with the T45.1x5A and was told I coded this incorrectly because you can not code "likely" as a professional coder, only a hospital coder. My provider seen the patient while they were inpatient, not outpatient. I do know when the patient is being seen as outpatient you can not code "likely" but I thought when they're inpatient status you can code as such. If anyone knows the answer to this as well as have any supporting documentation, I would greatly appreciate it. Thanks.

 

[carlystur]

Our guidelines for 2022 have this to say about inpatient coding with "likely" and similar language for diagnoses:

H. Uncertain Diagnosis
If the diagnosis documented at the time of discharge is qualified as “probable,” “suspected,”
“likely,” “questionable,” “possible,” or “still to be ruled out,” “compatible with,” “consistent
with,” or other similar terms indicating uncertainty, code the condition as if it existed or was
established. The bases for these guidelines are the diagnostic workup, arrangements for further
workup or observation, and initial therapeutic approach that correspond most closely with the
established diagnosis.
Note: This guideline is applicable only to inpatient admissions to short-term, acute, long-term
care and psychiatric hospitals.

 

[thomas7331]

The inpatient guidelines for coding uncertain diagnoses apply to facility claims only. This is stated in the ICD-10 official guidelines, though it requires a little bit of searching and reading to see it. If you look at the beginning of Selection II - Section of Principal Diagnosis (the section under which the 'Uncertain Diagnosis' coding guidelines fall) - it explains that this part of the guidelines applies to hospital reporting only. Physician coding does not fall under this section, and professional services are reported using outpatient guidelines, regardless of whether the patient status is inpatient or outpatient.

 

[Pam Warren]

As thomas mentioned, make sure you're reading the coding guidelines from the correct section of ICD-10. 'Inpatient' coding generally means inpatient facility coding; whereas coders abstract diagnosis codes and ICD-10-PCS codes to arrive at the appropriate DRG. This is vastly different from coding for physician's services....regardless of where they see the patient.

 

[ezavon4u@roadrunner.com]

following the comment from Thomas, where am I able to find the documentation (ICD-10-CM or CMS) to support the professional/physician diagnosis coding guidelines are to follow the outpatient guidelines during an inpatient encounter? Thanks!

 

[MargoR]

Hello all, need some assistance on somewhat the same scenario as professional services being done for inpatient and diagnosis assigned:

I have a patient that is covered under Texas emergency Medicaid. Texas ER Medicaid only covers services for emergency only, there is an old diagnosis (ICD9) list coverage that we did a crosswalk the ICD9 to ICD10.

Scenario:
Patient was admitted to hospital (primary MD) due to Abd pain (on the ER Medicaid DX list), primary MD ordered multiple studies. Patient was found with a cecal mass (new finding), and he has a history of cancer which metastasized to several parts of his body. Primary MD referred to surgeon for consult for cecal mass, consult report does not state Abd pain (or any other signs and symptoms).

Previously (another job), I was advised that when a patient is admitted and the course of this admission that we (coders) may use the entire record to review and use the diagnosis from other providers (not the labs, xrays etc. only providers notes).

Is this correct?