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Coding "Probable" diagnosis

  1. Question Coding "Probable" diagnosis
    Medical Coding Books
    Hi

    My ER doctors are informing me that I should be coding charts if they use the word "Probale" as their "Main diagnosis". From my knowledge of the "AMA" guidelines words that began with ruleout, probable, susupected, and questionable cannot be coded. Can someone tell me if this is still a general rule?

    Thanks,


  2. Default
    Outpatient coders should not code "possible", "probable", "suspected", "question of". We should choose a diagnosis from symptoms instead.

    ~L
    CPC, CGSC, COSC

  3. #3
    Location
    North Carolina
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    3,126
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    I'm with Treetoad...signs or symtoms.

  4. #4
    Location
    Albany, New York
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    456
    Default
    I agree with the previous two responses........
    Karen Maloney, CPC
    Data Quality Specialist

  5. #5
    Location
    Jacksonville, FL River City Chapter
    Posts
    74
    Default
    When coding for provider services (whether inpatient or outpatient), you are to use the coding instructions that appear in Section IV of the Official ICD-9 Guidelines for Coding and Reporting that appears at the beginning of your ICD-9 book.

    This section says:

    I. Uncertain diagnosis

    Do not code diagnoses documented as “probable”, “suspected,” “questionable,” “rule out,” or “working diagnosis” or other similar terms indicating uncertainty. Rather, code the condition(s) to the highest degree of certainty for that encounter/visit, such as symptoms, signs, abnormal test results, or other reason for the visit.

  6. #6
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    San Gabriel Valley
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    Default coding probable dx
    give your ER doc a copy of the ICD-9 Guidelines

  7. #7
    Exclamation Coding Inpatient Uncertain Diagnoses
    I'd like to update this thread. The 2012 ICD-9-CM Guidelines for Coding and Reporting, Section II. Selection of Principal Diagnosis, H. Uncertain Diagnosis, which governs inpatient care, states:

    If the diagnosis documented at the time of discharge is qualified as "probable", "suspected", "likely", "questionable", "possible", or "still to be ruled out", or other similar terms indicating uncertainty, code the condition as if it existed or was established. The bases for these guidelines are the diagnostic workup, arrangements for further workup or observation, and initial therapeutic approach that correspond most closely with the established diagnosis.
    Note: The guideline is applicable only to inpatient admissions to short-term, acute, long-term care and psychiatric hospitals.
    Best,

    Kimberly A. Sherman, MA, CPC
    Multi-Specialty Physician Coder/Entrepreneur
    kimberlyshermansd@yahoo.com
    www.physicianscodingservices.com

  8. #8
    Location
    Columbia, MO
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    12,527
    Default
    Quote Originally Posted by KimberlySherman View Post
    I'd like to update this thread. The 2012 ICD-9-CM Guidelines for Coding and Reporting, Section II. Selection of Principal Diagnosis, H. Uncertain Diagnosis, which governs inpatient care, states:

    If the diagnosis documented at the time of discharge is qualified as "probable", "suspected", "likely", "questionable", "possible", or "still to be ruled out", or other similar terms indicating uncertainty, code the condition as if it existed or was established. The bases for these guidelines are the diagnostic workup, arrangements for further workup or observation, and initial therapeutic approach that correspond most closely with the established diagnosis.
    Note: The guideline is applicable only to inpatient admissions to short-term, acute, long-term care and psychiatric hospitals.
    That guideline is and always has been for inpatient facility use not for physician codeing or hospital outpatient. Just to clarify.

    Debra A. Mitchell, MSPH, CPC-H

  9. #9
    Default
    I am getting this guideline from my 2012 Ingenix ICD-9 Physician coding book. It is under the "Official ICD-9 Guidelines for Coding and Reporting". Section II. Selection of Principal Diagnosis, introduction, states that "In determining principal diagnosis the coding conventions in the ICD-9-CM, Volumes I and II take precedence over these [UHDDS] official coding guidelines." It then goes on to enumerate what these guidelines are, which includes Section II.H. Uncertain Diagnoses.
    Best,

    Kimberly A. Sherman, MA, CPC
    Multi-Specialty Physician Coder/Entrepreneur
    kimberlyshermansd@yahoo.com
    www.physicianscodingservices.com

  10. Default
    Quote Originally Posted by mitchellde View Post
    That guideline is and always has been for inpatient facility use not for physician codeing or hospital outpatient. Just to clarify.
    Hi Debra,

    Just to make certain, so if our physicians are seeing patients in the inpatient setting and are not employed by the hospital, they CANNOT code off of probable, rule out, uncertain diagnosis?

    Whether facility coding (hospital) or physician billing, can a "resolved" diagnosis be billed? If it can under which scenario would that fall under?

    Thank you,

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