rule out

audii_girl

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I do physician coding for psychiatry in ED and acute care-

I'm trying to find resources to educate physicians when coding rule out, possible, probable or any uncertainty codes-

I want to explain/educate the difference between hospital/physician coding-

I know that for uncertainty codes, they can bill with DX with signs and symtoms to the highest certainty-

Does anyone have any resources?
 

AmandaBriggs

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You can find this information in the ICD-10-CM Official Guidelines for Coding and Reporting in Section IV - Diagnostic Coding and Reporting Guidelines for Outpatient services, subsection H - Uncertain diagnosis. It states, "Do not code diagnoses documented 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 encounter/visit, such as symptoms, signs, abnormal test results, or other reason for the visit. Please note: This differs from the coding practices used by short-term, acute care, long-term care and psychiatric hospitals." This was on page 107 of the 2017 guidelines that I have.

I hope this helps :)
 
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