sequence of diagnosis personal vs family history

pkcamp

Guest
Messages
1
Best answers
0
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.
 
Messages
811
Best answers
0
"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.
 
Top