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Thread: ER Visit: Chief Complaint vs. 1st Diagnosis as primary?

  1. #1
    Join Date
    Apr 2007
    St. Paul, MN.

    Question ER Visit: Chief Complaint vs. 1st Diagnosis as primary?

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    Hi Everyone!

    A provider initially billed the following:
    Diag #1: 465.9 ACUTE URI UNSPEC
    Diag #2: 787.03 VOMITING ALONE

    Because of their contract, this prompted us to pay them a particular amount that's lower than a regular "emergent visit."

    They then billed us again, and switched the codes, sending along the medical record for the visit.

    That patient's "chief complaint" was vomitting, however, the first diagnosis listed in the record is URI, with #2 being vomitting.

    Which of these is most appropriately used for the primary diagnosis?


    Jodie S.
    Last edited by dreampeddler; 05-08-2009 at 01:18 PM.

  2. #2

    Default Vomiting

    The reason the patient came to the ED is generally coded first. If the patient came to the ED primarily because they were vomiting; and the ED doc determined that it was a symptom of a URI, the more emergent diagnosis would be acceptable since the ED physican had to respond to that complaintwith at least moderate MDM to determine what the cause was. For a 4 I would be looking for some intervention; IV fluids, labs, X-Ray, meds. If none of this was done it would probably be a 3.


  3. #3
    Join Date
    Apr 2007


    According to instructions in ICD09 manual, in Section IV (H) it states "List first the ICD9 code for the diagnosis, problem or other reason for the encounter shown in the medical record to be chiefly responsible for the services provided."

    If the patient came to the ED primarily because he or she was vomiting, I would use vomiting as the primary dx. Rule of thumb in ED coding is to use the reason for patient's visit to the ED as a primary dx code. HOpe that helps.

  4. #4
    Join Date
    Apr 2007
    Bangor, Maine


    When I code ER's I code what the doc documented as the final Dx. If the vomiting was a sign or symptom of the URI, then it doesn't need to be coded at all. If it is an additional dx then I would code that as well, depending on how the physician sequenced them. What did the physician document as the primary dx? I would go by that.

  5. #5
    Join Date
    Apr 2007
    Columbia, MO


    I agree with Leslie, it is considered redundant to code a symptom that is explained by the definitive dx. However if the URI was not the cause of the vomiting and that is why the pt was there then I would do the vomiting first followed by the URI.

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