We have struggled with our providers using the diagnosis of 'post-concussion syndrome' (F07.81) on patients that have only recently been injured.
From our perspective, we need more information from the providers in order to assign this code. Insurance will deny the claim if F07.81 is primary because the coding instructions with F07.81 indicate to "Code first the underlying physiological condition". The only other guidance I have found online is people indicating to code the concussion with 7th character S. The problem with that is that you can't assign an injury code with 7th character S as a primary diagnosis either, insurance will deny that as well.
This still leaves us with the question of what do we code as primary in this case?
How do you explain to your provider that if the concussion happened a week ago it's probably still an active concussion and the symptoms the patient is experiencing are still part of that process so coding the encounter as either the initial or subsequent concussion makes more sense and is probably more accurate.. :/
Thanks for your help!
Sara
From our perspective, we need more information from the providers in order to assign this code. Insurance will deny the claim if F07.81 is primary because the coding instructions with F07.81 indicate to "Code first the underlying physiological condition". The only other guidance I have found online is people indicating to code the concussion with 7th character S. The problem with that is that you can't assign an injury code with 7th character S as a primary diagnosis either, insurance will deny that as well.
This still leaves us with the question of what do we code as primary in this case?
How do you explain to your provider that if the concussion happened a week ago it's probably still an active concussion and the symptoms the patient is experiencing are still part of that process so coding the encounter as either the initial or subsequent concussion makes more sense and is probably more accurate.. :/
Thanks for your help!
Sara