Wiki Physician wants proof

[jperkins]

I have a physician who is insisting I code a "suggestive of" diagnosis as the definitive diagnosis. I know that I was taught not to code an uncertain diagnosis but I cannot remember where the rule is printed in black and white which is the only thing that will convince this physician. I found several things on the internet but nothing hard and fast from AAPC. Can anyone point me in the right direction to find this rule? Thank you.

 

[JDACPC]

Here's an HCPro article that cites the Coding Clinic with the "black and white" info you need:

http://www.hcpro.com/HIM-274483-5707/QA-Suggestive-documentation-could-require-clarification.html

 

[dclark7]

Your proof is the Official ICD-9-CM Guidelines for Coding and Reporting. Section IV. Diagnostic Coding and Reporting Guidelines for Outpatient Services, Paragraph I Uncertain Diagnosis states "Do not code diagnosis docuemnted as "probable", "suspected", "questionable", "rule out", or "working diagnosis" or other similar terms indicating uncertainty. Rather code the condition(s) to the highest degree of certainty for that encoutner/visit, such as symptoms, signs, abnormal test results, or other reason for the visit." It goes on to say"Please note: This differs from the coding Practices used by short-term, acute care, long term and psychiatric hospitals."

If you don't have access to ICD-9 books you can find the guidelines on the CDC and WHO websites.