AAPC - Back to school
Results 1 to 2 of 2

Thread: E&M diagnosis chief complaint?

  1. #1

    Default E&M diagnosis chief complaint?

    AAPC: Back to School
    I recently read an article that stated on the initial office visit to use the chief complaint diagnosis first and the physician's rendering diagnosis second. I am a little confused because if the patient comes in with radiographic studies and the physician can actually render an informed diagnosis, should we not use or list the confirmed diagnosis first?


  2. #2
    Join Date
    Apr 2007
    Kansas City, MO


    I tend to only use the ICD-9 guidelines when it comes to diagnosis coding.

    Section 1, Item 6. Signs and Symptoms - Codes that describe symptoms and signs, as opposed to diagnoses, are acceptable for reporting purposes when a related definitive diagnosis has not be established (confirmed) by the provider.

    If you have a diagnosis at the end of the visit, it is all that is needed. If not, use signs and symptoms. They are normally stated in the chief complaint and carried through the documentation. I would be very wary of following advice that differs from the actual guidelines.
    Angela Jordan, CPC
    AAPC of Kansas City
    National Advisory Board Representative Region 5

    Medical Revenue $olutions
    Senior Managing Consultant


Similar Threads

  1. Chief complaint vs primary diagnosis
    By biker62 in forum Billing/Reimbursement
    Replies: 4
    Last Post: 10-18-2013, 06:59 AM
  2. Chief complaint vs. Diagnosis
    By vmounce in forum Gastroenterology
    Replies: 0
    Last Post: 07-15-2011, 10:26 AM
  3. Chief Complaint & HPI
    By nperry in forum Medical Coding General Discussion
    Replies: 1
    Last Post: 02-18-2011, 02:15 PM
  4. Chief Complaint & HPI
    By nperry in forum Medical Coding General Discussion
    Replies: 0
    Last Post: 02-15-2011, 11:29 AM
  5. ER Visit: Chief Complaint vs. 1st Diagnosis as primary?
    By dreampeddler in forum Emergency Department
    Replies: 4
    Last Post: 06-16-2009, 11:49 AM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts

Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?


Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.