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Specialist Diagnosis Coding

  1. Default Specialist Diagnosis Coding
    Medical Coding Books
    What is the official guideline to coding a diagnosis submitted by a specialist for Medicare Advantage Plan purposes for a PCP?

    Can we code from the specialist report directly, does it have to be signed by the PCP, or does the PCP have to document the diagnosis/condition onto their progess notes for us to code it?

    If none of the above apply, please explain if, when and how we can code from a specialist visit report seen at the PCPs chart?


  2. #2
    Milwaukee WI
    Default Each note stands alone
    If I understand your question correctly, you are wanting to code the diagnosis from a different provider (specialist) for a visit with the PCP. I would NOT do that.

    I would code only what the PCP him/herself recorded as diagnosis. Just because a specialist sent a report with his/her findings/opinion does not mean that the PCP is in agreement, or is treating that condition.

    F Tessa Bartels, CPC, CEMC

  3. Default
    Are you talking about HCC coding? If so, we have been told that regardless of who did what in that chart (other than nurses, etc) you pick it up. I personally do not feel this is fair as the PCP or physician has no control on the note sent to them, but nonetheless that is what I was told you do.... I hope this helps.

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