Wiki Order of Dx

[jhynek]

Hi all! Anyone know if the order of diagnoses in the assessment in the chart needs to match how they are on the claim? We are a little different in the fact that our providers do all of their own coding, and there are not coders reviewing anything before it goes to insurance. They are able to re-order the assessments before submitting to superbill in our EMR, however it does not change the order of diagnoses in the chart note. I do not know if it matters or not?

Example
Assessment: 1. L57.0 2. L70.0 3. Z85.820

Provider clicks re-order prior to submitting their charges and they put 1. Z85.820 2. L70.0 3. L57.0

Should the order be the same in both the chart note and claim or does it make no difference?

Thanks!!!

 

[devinmajor14]

It really depends on the coding guidelines and what they are coding. Some codes cannot be primary and others require to be coded after another code.

 

[jscitelli]

Gotta love physician's who code but don't understand it. In the ever popular desire to save money, companies are bypassing credentialed coders and forcing physicians to do it - who, interestingly enough really don't WANT to do it. In the end, it costs the company more money in delays, resource utilization etc etc. (plus you end up with very irritated physicians!)

OK off my soap box - the order of diagnosis is important regardless of setting, the first listed condition or primary diagnosis is, after exam and study, the reason for being seen (inpatient) regardless of how it is listed in the assessment - UNLESS the physician puts "primary" next to the diagnosis (starting to see that). In a clinic/office setting it may only be a symptom diagnosis if no results or confirmatory evidence is present to support an actual diagnosis.

Specific to your question, I've never seen anything about matching a claim - the big issue is the first/primary condition per coding guidelines.


Jaymie Citelli RN, CMAS, CCS, CPC, COC, CRC, CDEO
Auditor - himagine solutions, inc.