Wiki Specialist Diagnosis Coding

[MRAAUDITOR]

What is the official guideline to coding a diagnosis submitted by a specialist for Medicare Advantage Plan purposes for a PCP?

Can we code from the specialist report directly, does it have to be signed by the PCP, or does the PCP have to document the diagnosis/condition onto their progess notes for us to code it?

If none of the above apply, please explain if, when and how we can code from a specialist visit report seen at the PCPs chart?

Thanks

 

[FTessaBartels]

Each note stands alone

If I understand your question correctly, you are wanting to code the diagnosis from a different provider (specialist) for a visit with the PCP. I would NOT do that.

I would code only what the PCP him/herself recorded as diagnosis. Just because a specialist sent a report with his/her findings/opinion does not mean that the PCP is in agreement, or is treating that condition.

F Tessa Bartels, CPC, CEMC

 

[eadun2000]

Are you talking about HCC coding? If so, we have been told that regardless of who did what in that chart (other than nurses, etc) you pick it up. I personally do not feel this is fair as the PCP or physician has no control on the note sent to them, but nonetheless that is what I was told you do.... I hope this helps.