Wiki Risk Adjustment Article in Coding Edge 8/2012

[TonyaMichelle]

The second to the last paragraph on page 19 in Coding Edge 8/2012 states,"Remind your providers that CODERS MAY NEVER ASSUME".

I would agree with that statement, but, in the ICD9 coding guidelines for "Hypertensive Heart and Chronic Kidney Disease", it states:

"Assign codes from combination category 404, Hypertensive heart and chronic kidney disease, when both are stated in the diagnosis. Assume a relationship between the hypertension and chronic kidney disease, whether or not the condition is so designated...."

Also, under Hypertensive Chronic Kidney Disease, the guideline states:

"Unlike hypertension with heart disease, ICD9CM presumes a casual cause-and-effect relationship and classifies chronic kidney disease(CKD) with hypertension as hypertensive chronic kidney disease."

So would I be correct to assume or presume in this category?

 

[hcassano]

Dear Reader,

I would say follow the AHA Coding Clinic Guidelines - The overall general rule of thumb is never to assume. However, if the rule dictates to code based on the assumption in specific areas of coding, then follow the directions.

As a seasoned coder, assumption coding is never acceptable and that is what the reference is to.

Thanks,

Holly