Wiki Using all diagnosis codes?


Bremerton, WA
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We recently had a patient come in for an ulcer follow up. The doctor charged a 99212 for the visit. The doctor noted that the ulcer was healed, trimmed some callous tissue and counseled the patient some on his edema. The diagnosis codes in the note were 707.15 ulcer, 250.00 diabetes, and 703.8 disease of nail. I have no idea why the 703.8 was in the assessment but when I queried the doctor to add the corns/callous diagnosis (700) and the edema (782.3) he stated that since the patient only came in for the ulcer follow up, (not his edema or callouses) all I would need to use is the ulcer as the diagnosis for the OV. This is not what I had thought was correct coding, (granted I just got my certification) but should I not code the OV with diagnosis codes 707.15, 700, 782.3, and then 250.00??? I thought that you should code each diagnosis on an OV that the patient either presented with or had treated. Any help would be greatly appreciated....
I would be interested to know more information on this as well. I have been billing for a Podiatrist for 5 months now and am seeing the same thing. The doctor does all of the coding but is giving me more responsibility on it. He rarely ever puts more than one Diagnosis code for the OV or any procedures even though 4 or 5 diagnosis codes may be listed. I haven't really had a problem with claims getting paid because of this. But, for example, if there are 4 diagnosis codes listed, shouldn't all of them be used for the procedure or E/M codes?


CC: Patient presents with complaint of thick, painful nails, and he is on coumadin therapy as well

Impression: Onychomycosis, Tinea Pedis, Coagulat Defect Nec/Nos

Treatment: Debrided 6 or more toenails, specifically nails 1,2,3,4,5 left and 1,2,3,4,5 right. Nails that were debrided appered dystophic, gryphotic, hyertrophic. Patient relates painful ambulation. In addition, the patient is not able to reach down and trim nails on their own.
Lamisil get recommended to apply to webspaces BID for one week.

Diagnosis listed: 110.1 Onychomycosis, 110.4 Tinea Pedis, 286.9 Coagulat Defect Nec/Nos

The claim shows 99203 with 110.4 DX and 11721 with 286.9 DX. Shouldn't 110.1 be put in there somewhere? I'm assuming it should be the second DX for 11721.
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