• If this is your first visit, be sure to check out the FAQ & read the forum rules. To view all forums, post or create a new thread, you must be an AAPC Member. If you are a member and have already registered for member area and forum access, you can log in by clicking here. If you've forgotten the password it can be reset on our sign in section by entering your registered Email Address or Username here. To start viewing messages, select the forum that you want to visit from the selection below..

sequence of diagnosis personal vs family history

P

pkcamp

Guest
Messages
1
When a patient has a personal history of polyps and a family history of polyps what is the correct order for the diagnosis? If personal history is listed first the insurance will apply to the deductible. If the family history is listed first the insurance will pay in full as a screening. What are the guidelines for ICD 10 on this? If there is any documentation out there to show the order of the diagnosis for this scenario I would love to see it.
Thanks for the help.
 
"Personal history codes may be used in conjunction with followup codes and family history codes may be used in conjunction with screening codes to explain the need for a test or procedure."
https://www.cms.gov/medicare/coding/icd10/downloads/2016-icd-10-cm-guidelines.pdf

If the patient has a "personal HX of" then that means they've already been diagnosed with, and likely treated for, a condition in the past. Since it has already been established that the patient has the condition, billing for a screening based off family HX would no longer apply. You wouldn't use both on the claim, you'd use the personal HX code for all visits.
 
You must log in or register to reply here.
Top