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co morbidities

  1. #1
    Default co morbidities
    Medical Coding Books
    Can someone please tell me when it is appropriate to code comorbidities for a specialist visit? We are being put on a lower fee schedule with Blue Cross of Idaho because we only code out what we treat . According to BCI, they want to see how sick our population is w additional dx codes if they are present and documented such as diabetes, htn etc......

    We are a Neurosurgery office and have asked different sources how to code ICD 10 appropriately and have been given many contradicting answers stating that we should only code what we treat then we are also told that we need to include the co-morbidities even when we are seeing a patient for a specific reason. An example is- a patient with a disc that also has COPD that needs a hemilaminectomy and microdiscectomy to remove the disc problem. We would normally code this as 99205-57 M51.16. Should we add J44.9 for COPD?

    Please help !!!!!

    Thank you,

    Stephanie

  2. #2
    Default
    The ICD-10 guidelines instruct to report "all documented conditions that coexist at the time of the encounter/visit, and require or affect patient care treatment or management" so you should be including diagnosis codes for any conditions that the providers document as playing a role in their treatment plan for the patient - it doesn't have to be a condition that they are treating, but if they are having to take that condition into consideration for management of the patient, then it should be reported.

    Comorbidities and chronic conditions definitely do affect treatment decisions that providers have to make when planning a surgery (especially something such as significant as COPD which will affect the level of risk, anesthesia, post-operative medications, etc.) but if your providers' documentation does not reflect this and it is causing your reimbursement to be lower as a result, then you may need to conduct some education with the providers to ensure that their documentation is adequately representing the true complexity of their patients so that you can code appropriately and get the level of payment that compensates for the level of work the providers are doing.
    Last edited by thomas7331; 06-13-2018 at 06:47 AM.
    Thomas Field, CPC, CEMC

  3. #3
    Default
    Thank you so very much for this helpful information!!!

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