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ICD coding for “resolved conditions”

  1. Smile ICD coding for “resolved conditions”
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    Hi All,

    Please guide me ICD coding for “resolved conditions”.

    As per the general coding guidelines we would not code for any resolved conditions since the condition is no longer exists. But we come across the condition “resolved pneumonia”. Under pneumonia in ICD 9-CM index we noticed the non essential modifier for pneumonia is mentioned as unresolved as well as resolved pneumonia.

    Let me know how to code, 1) resolved pneumonia and 2) history of pneumonia.

    Can we code as 1) 486 (even if the condition is resolved as per the document)?

    If the physician evaluates for the condition and the same condition is resolved, we code the history. But in this scenario mentioned above can we code the resolved pneumonia as 486 or V12.61.


    Subashini, CPC, CPC-H

  2. #2
    Thumbs up
    When looking up pneumonia in the ICD 9 book, it lists (resolved) in the description with 486 as the code. That's what I have been doing.

  3. #3
    Columbia, MO
    Several years ago there was a coding clinic on this subject. If the return visit is to followup on an infection such as pneumonia, UTI, otitis media, etc. then you code the acute infection code as the reason for the encounter since we must assume that condition still exisits and is the reason for the visit. If on that encounter the infection is deemed resolved then if the physician requests another followup encounter the 3rd visit is coded as a V67.x code for followup.
    It made sense to me then and still makes sense today.

    Debra A. Mitchell, MSPH, CPC-H

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