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joanmurphycpc

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Manifestation codes for specialists

When coding for a specialist, the manifestation code can not be the principal diagnosis(which happens to be his specialty). For example: the specialist is a retina specialist the patient has diabetes which is affecting his sight.
A manifestation code must be use because the underlying cause is diabetes, however the billing manager wants to use the manifestation code as the primary diagnosis. They feel because they are specialists we should use their diagnosis codes(362.XX etc.)

Could you send me some written documentation to prove to them they are making a mistake?
A quick reply would be greatly appreciated.
 
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Check out your version of ICD-9. In the conventions, it clearly states that manifestation codes (such as Diabetic retinopathy) are to be coded as shown in the guidelines and alphabetic index. The same conventions are again stated in the tabular. ICD-9 Guidelines are followed, irrespective of the site of service or provider of service.

You may also reference Faye Brown (AHA Publications) on this matter and AHA Coding Clinic.

Hope this helps.
 
Go here: http://www.cdc.gov/nchs/datawh/ftpserv/ftpicd9/icdguide07.pdf

These are the 2007-2008 "Official ICD-9 Coding Guidelines" directly from the CDC. Actually, they're the same guidelines that you can find in your ICD-9 book, but I think they're easier to read!

Check out page 8. I was going to cut & paste some of it, but there's so much, including how to code for scenarios like yours.

You can help your supervisors understand the correct ways of coding, but you may not be able to get them out of the mind-set that "it paid, therefore it's not wrong." IMHO our industry is becoming more & more ICD-9 driven regarding procedures and it's becoming more & more important to learn how to use the guidelines to code properly.

If you don't try, though, it's 100% of failure - so here's the start for you, with the Guidelines that you can share.

Wishing you the best!

Leslie Johnson, CPC

http://www.askleslie.net
 
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