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Primary diagnosis question

  1. #1
    Default Primary diagnosis question
    Medical Coding Books
    Okay, I have 3+ years of coding, which means I am not a rookie, but probably still green. I have learned coding conventions, etc......but it seems that when I re-read the ICD-9 coding guidleines, my interpretation differs from other peoples, yet some also agree with me which makes it even more confusing. Case in point, I code for a GI group, and I code the facility side of things. When a patient has a colonoscopy for diarrhea, diarrhea would be my admit diagnosis. If a polyp happens to be removed, and a Clo test performed and found to be negative, I would assume diarrhea is the primary diagnosis followed by the polyp (for being an incidental find). But some of my coding associates tell me to use the polyp as the primary because its not a sign/symptom code, and 787.91 is. However, I state that the reason for the encounter and testing was the diarrhea, which should be primary. This leaves me to question myself and since some people agree and others disagree it becomes frustrating at times.

    Also, guidelines state that when a definitive diagnosis is made, signs and symptoms of the disease process need not be added as additional diagnoses, but using the same scenario from above, many times I'll get diarrhea as admit diagnosis and a definitive would be Crohn' primary would be the Crohn's, but since diarrhea is a symptom of Crohn's I would not place it as a secondary diagnosis, yet I would be told to do so. Again, its very confusing and it seems to be the rule where you'd code the way the employer wants you to, not by the guidelines. Does anybody else feel this way, or am I way off on my coding? Thanks.


  2. #2
    International Member

    Don't worry.... It happens with me also... Just go thro' what your client needs... Be'coz I was working with Clients who specified to code for associated symptoms also & now working with Client who didn't need associated symptoms...!

    And yaa... sometimes we get confused , but then just talk with your seniors or clients as ICD guidlines shows this or that so what is the coding sequence... And most of the cases they helps!

    Ok... Hope this helps!


  3. #3
    Columbia, MO
    The guidelines specify that you do not code the symptoms when the definitive dx explains the presence of the symptom, to do so is redundant. But when the symptom could be indicative of something else and the finding is incidental then you code both and the finding being incidental is secondary.

    Debra A. Mitchell, MSPH, CPC-H

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