Wiki Resolved

[minoweka]

I have several encounters where provider states "RESOLVED" in the assessment and also lists the code for the condition/disease as if it were active/current. For example: Left groin pain - R10.30 RESOLVED Call if worse.

My understanding from the guidelines is that when a condition is RESOLVED a code from
"Z08-Encounter for follow-up examination after completed treatment for malignant neoplasm" or
"Z09-Encounter for follow-up examination after completed treatment for conditions other than malignant neoplasm" should be used in conjuction with history codes to provide a full picture of the healed condition. The follow up code is sequenced first, followed by history code.

Above scenario would then be recoded as:
Z09 - Encounter for follow-up examination after completed treatment for conditions other than malignant neoplasm
Z87.898 - Personal history of other specified conditions.

Is my understanding correct? Thank you for your input.

 

[kak6]

It sounds as if patient presented with pain and the pain resolved during the visit. Maybe they were given pain meds? you don't say what the treatment plan was. If the pain was addressed then yes R10.30.
Z09 would be as it is stated in the code description "follow-up' after completed treatment for conditions -- what it is stating here is: this is a follow-up visit for a patient that has been seen previously for a condition that I (the provider) have treated on a previous visit and now I am just following up on my treatment plan. So that code I do not think is what you are looking for.