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Dx rule in Inpatient setting pro fee

  1. Default Dx rule in Inpatient setting pro fee
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    Hello, I would greatly appreciate your expertise in the following scenario that leads to the general question 'Do we code the condition as it still exists or a history of the condition when MD write Progress Notes during multiple subsequent visits and the surgery was already done on day #1?"
    Example, A/P day 3 etc "Female with SAH (hemorrhage) on 3/10 due to Right PCoA aneurysm, s/post balloon-assisted coiling on 3/11. Vasospasm treated with IA Verapamil 3/15, 3/18. Stable neuro exam
    - Vasospasm watch
    - TCD today
    -Plan for cerebral Ag Thursday
    -Following"
    Do we still code I60.31- aneurysm w/hemorrhage and Z98.890- post procedural state even though it's been operated and no hemorrhage exists OR we code History of hemorrhage + Z98.890?
    Thank you very much.

  2. #2
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    Coding guidelines general apply to coding for a patient 'encounter' and not for a specific point in time within an encounter. Since an inpatient stay at a facility is considered a single encounter, the diagnosis that is the reason for admission will also be the diagnosis that is considered the reason for the treatments throughout that encounter until discharge. So in my experience, coders do not typically code differently for pre- and post-operative portions of that same encounter. Some practices I've worked with have coded the diagnosis of all the hospital professional fees strictly from the hospital's facility diagnosis codes, and to my knowledge, this has never created a problem in reimbursement or audit findings. But practices may vary on how they choose to do this depending on what documentation they have access to and/or payer guidelines or internal policies, so it may be something you would discuss with your leadership for additional guidance.
    Last edited by thomas7331; 04-14-2019 at 12:15 PM.

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