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Help with coding/sequencing

  1. Default Help with coding/sequencing
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    I have a record with Dxs: NIDDM/CRF (Chronic renal failure) and the second Dx is HTN/CRF. I coded 250.40, 585.9, and 403.90. My question is that since two DXs require that you use a code for the CRF (585.9) but you can only report it once per DOS, how do you sequence this. My training department at Outcomes can never seem to answer the question asked.

  2. #2
    Columbia, MO
    I queried a physician I work with a lot and he stated the CRF cannot be causal to both the HTN and the diabetes at the same time on the same pt. Also since the HTN and the CRF are always linked then the CRF would be causal to the HTN and then possibly exacerbated by the diabetes in which case the diabetes would be the 250.00 code. as far as which goes first it really depends on the documentation, what does the physicians narrative say?

    Debra A. Mitchell, MSPH, CPC-H

  3. Default
    You mean the physician's chicken scratch. Simply NIDDM/CRF and HTN/CRF. Actually to be honest I don't like coding anything but the NIDDM, since there is not much in the body of the note anyway. Not really a whole lot in the way of documentation. Thanks for your help.

  4. Default
    By the way, I was about to do exactly what you said and code:250.00, 403.90 and 585.9, but I figured I'd let my training dept get back to me with a suitable answer. I won't be holding my breath.

  5. #5
    Columbia, MO
    I hope everything turns out for you. The people at outcomes contacted me about a job, they were very rude during the interview and I turned it down, sounds like I made a good decision.

    Debra A. Mitchell, MSPH, CPC-H

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