Wiki Need help with diagnosis code-Chart Notes for

[ahp-tvh]

Chart Notes for visit
Illness Care
HPI Given By: grandmother
Chief Complaint: toe nail and finger nail off
History of Present Illness: The patient has a history of losing toenail on 3rd toe on L toe. No noted injury. No redness noted.
Now with finger nail which has come off a few weeks ago.
Fingernail on 5th finger on R hand.
No h/o trauma to hand. No redness or swelling noted. No scaliness noted.
No other hair loss. No illness noted. Still has baby teeth.


Problem # 1: WORRIED WELL (ICD-V65.5)
likely past trauma to nailbeds which have caused them to fall off and have new nail grow in its place.
Observe for any signs of infection (redness or peeling) or if new nails falling off. Rest of nails appear normal.
Orders:
Ofc Vst, Est Level III (Expanded) (CPT-99213)

also tried V71.89 0 - other specified suspected conditions.

Insurance is not liking either of these diagnosis any suggestions for a different code?

 

[btadlock1]

Probably because you're using V-codes with a sick visit, if I had to guess. A lot of payers don't like that...you can tell if the denial is something along the lines of "this service isn't covered for this diagnosis." Is there not a diagnosis that would describe the nail condition? Sorry I don't have my book handy to give you an accurate example, but maybe something like 110.1?

 

[~*Audra*~]

I would use 703.9 since you don't know what is causing the nail to fall off. It says "likely trauma" but we can't code that, so I would go with the unspecified nail code.

 

[louLNC]

Lcardillo, R.N. B.S. CPC

I would agree to code with 703.9. The child is not ill, although may have an underlying skin or autoimmune disease. But, for now you only have the nail condition. And because there is a code for the specific complaint the insurer will reject the V codes.