Wiki Strep/Icd 10

[Mnmark442]

Hi all,

I am hoping someone can help me out. I have been assigned to pediatric coding which is not my usual specialty. I am seeing numerous patients come in for sore throat and fever. My provider is coding:

J02.8 Acute pharyngitis due to other specified organisms
and
R50.81 Fever presenting with conditions classified elsewhere


Our provider is not coding the primary dx since these are manifestation codes so I have been changing them to J02.9 and R50.9 (acute pharyngitis, unspecified and headache, unspecified). I notice some claims go out and are fine, while others clearly state you can’t use the manifestation codes as primary. Does anyone else see this? I am just looking to confirm I am changing the codes correctly.

Thank you!

 

[thomas7331]

There are different issues going on here. First of all, these aren't manifestation codes - I think you mean that these are codes that have a 'use additional code' instruction, and for which the provider has not given you the necessary information to assign the required additional code. Second, ICD-10 guidelines require that codes be assigned based on the provider's statement of the diagnosis or condition that exists. So whether or not their code is correct really depends on what they've documented in the note. If you're changing their code to match what's in their note, then you're fine - your new code will be supported. On the other hand, if you're making an interpretation of what you think they meant when they picked this code, then you're in rather risky territory. Technically, you really should query a provider for clarification rather than assume that they meant something that would have resulted in a different code.

This is a common dilemma coders are faced with when providers are asked to select codes rather the dictate a diagnosis in their own words. If the providers aren't documenting a diagnosis and are just selecting a code and using the code descriptor as substitute for documenting a diagnosis, (and are selecting incorrect codes as well), that's a provider education issue and needs to be addressed. That's something you'd need to discuss with your manager and get guidance from them as to how they would like you to proceed with this.

Just an additional note - I see you've posted this question four times on the forum - please avoid duplicate posts as it's unnecessary and technically again the forum rules. One post is usually sufficient.

 

[Mnmark442]

Hi,

Thank you for your feedback. You have confirmed what I am changing the ICD 10 codes to are correct, given the provider is not documenting a primary code to go along with them (such as a virus).

I actually thought I only posted the question 2x's, as I was doing it from my phone it and it was not showing up as posted, so I tried different threads. I do not always get a response and noticed some forums are not as "lively" as others, so wanted to try on a more general discussion and a specific. That being said, the rule has been noted.

Thank you, again