Wiki Post-concussion Syndrome primary Dx

[sarapher]

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

 

[Cynthia Hughes]

If the patient was recently injured (eg, within 1month), the care provided is subsequent care (during healing) and the 7th character D is appropriate. As symptoms vary, it seems appropriate to report symptom codes as well.
However, when a cluster of symptoms that meet the diagnostic criteria for post-concussion syndrome (eg, DSM-5 criteria) persist beyond the usual recovery period and this diagnosis is assigned, F07.81 is appropriately reported. Then a code for the related concussion would also be reported with 7th character S would additionally be reported as instructed by a note to F07.81.

I hope that helps.
Cindy