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Thread: CAH Method 2 Diagnosis coding help

  1. #1

    Default CAH Method 2 Diagnosis coding help

    AAPC: Back to School
    HI all!
    I have a unique scenario that I am searching documentation on if anyone here can lend a hand in finding the rules that would be great....here goes...

    I work for a facility that is a CAH with 5 outlying clinics...our family practice physicians are employees of the facility as I am....I am a CPC and code for the physician side of the services ranging from E/M levels in the clinic setting as well as inpatient physician in the hospital setting as our main clinic is attached to the hospital by a sidewalk....we have certified coders in the hospital that code all outpatient labs and floor charges...there has been talk recently that since we are CAH that it would be appropriate to combine coding since most all of our patients that are seen in our main clinic walk over tho the hospital to receive x-rays and or lab work and the reports all go into one system and the bills all go out on one bill....not always does the clinic dictation from which I code from reflect the outcome of the lab results per the Dr.s dictation....I go by the if it isn't documented the patient doesn't have it and so on....the goal behind all of this is to streamline and have fewer diagnosis on the claim...from what I have read so far when it comes to outpatient services the doctor would have to ammend his dictation to reflect the lab or x-ray findings....I am wondering how all of this is supposed to work, as the scenario could be reversed....would it be appropriate for example to code a UA with "dysuria" on the initial order and the clinic visit be coded a "UTI" or would it be more appropriate to follow the clinic dictation since it would be available and code the UA as a "UTI" as well? I would worry that eventually medical neccisity for tests would become a problem....?
    The answer I keep getting is we are one facility...which I understand but within our facility don't we have to follow coding rules for the location we are providing the service under...next when I say that I get the "but we are CAH" and I can't seem to find any rules or documentation that support changing the method in which you would assign DX codes.
    The other thing they are trying to streamline is less hands (coders) touching the same patient encounter...I code the E/M and someone else codes the labs and they think that if the same person codes the whole thing then we would be more likely to assign less codes....not that I'm too excited about being thrown into coding hospital and physician...seems to me there are so many variables and rules to keep up with what you can and can't do seperate....any thoughts on that out there?
    Thanks much to whom ever wants to tackle this one...!!!!

  2. #2
    Join Date
    Apr 2007
    Loma Linda CA

    Default Cah method ii

    I realize your frustration - I also work at a CAH but I code for the facility side. Medicare's rules are that if the clinics are utilizing the facilities tax id # that all services must be on one claim (combined). What type of software is the billing department utilizing is my first ? and are you coding the the x-rays prior to the reports being read by the radiologist?

    - google the CAH METHOD II billing - you will be amazed at what you find -


  3. #3


    We are using Meditech for the billing software, and yes for our MCR claims they are all going out on one bill, a UB...a hospital coder codes the faciltity portion and I code for the 983 rev code for the physician...my 4 dx I get to use for my code often differ from what they are allowed to code according to their rules....so my question is that does being CAH allow us to ignore the "location" rules for diagnosis coding? And MCR is the only one that requires us to use one claim...what will happen with all other payers if this is enforced?
    Thanks Much
    Hope that is clear as mud!!!!

  4. #4
    Join Date
    Apr 2007
    Columbia, MO


    Actually for the dx the coding guidelines as outlined by the CDC over rule. On the first page of the guidelines it states that these are a set of rules and required to be adhered to under HIPAA. As far as code the symptom vs definitive, you are allowed to code what you know at the time of coding,or after study. So if the CAH wishes you to hold the coding until the results are back and have the documentation amended to reflect the result, there is no problem with this at all. As far as location, I am not certain what you mean but if the guidelines indicate a code is first-listed then it is.

    Debra A. Mitchell, MSPH, CPC-H

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