Inpatient coding is not my areas of expertise. However, I would suggest the following:
As per ICD guidelines "Additional signs and symptoms that are associated routinely with a disease process should not be assigned as additional codes, unless otherwise instructed by the classification.
As per ICD 9 the dx "997.4" excludes "564.3". Hence, it is appropriate to report "564.3" as an additional dx.
Hope this helps!
Abdul Saleem CPC
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