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Chronic Conditions Listed in PMH

  1. #1
    Location
    St. Louis West, MO
    Posts
    29
    Question Chronic Conditions Listed in PMH
    Medical Coding Books
    In an outpatient (physician) medical record, when a chronic condition is listed in past medical history (not a problem list) and is not monitored, evaluated, addressed/assessed or treated during that visit (other than the fact it is listed in PMH) can you code that condition?

    I'm looking for opinions, please, and any supporting documentation.

    Thanks, everyone!

    Serine

  2. #2
    Location
    Stuart, Florida
    Posts
    331
    Default
    In outpatient coding, when any condition, including a chronic condition, is listed in PMH but is not addressed at all, it is not to be coded. There must be some active treatment.
    Vanessa Mier, CPC

  3. #3
    Location
    Wenatchee Washington.
    Posts
    24
    Default
    ohn0disaster ~
    Do you know where one could look that up or have the link handy?
    I would love to be able to print/copy this information and pass it out here at work.

  4. Default
    I would have to disagree. If the pt is diabetic or has hypertension, although the physician does not document that he treated that condition, it can have bearing on how he treats the condition the pt came in for. Just for instance, say the pt has hypertension and presents with seasonal allergies. There are certain medications that the doctor cannot prescribe due to possible interference with the management of the hypertension. Most every place I have ever worked required that hypertension, diabetes and certain other conditions be picked up regardless of if that physician specifically treated them in that visit.

  5. #5
    Location
    St. Louis West, MO
    Posts
    29
    Default
    eadun2000 - if the doctor doesn't document the fact that the condition plays into his MDM for that day, how can you assume it did? Our rule is if the condition was not monitored, evaluated, addressed, assessed, or treated that we do not code the chronic condition in PMH. We coders cannot make assumptions.

  6. Default
    Quote Originally Posted by serhaug View Post
    eadun2000 - if the doctor doesn't document the fact that the condition plays into his MDM for that day, how can you assume it did? Our rule is if the condition was not monitored, evaluated, addressed, assessed, or treated that we do not code the chronic condition in PMH. We coders cannot make assumptions.
    Please read your coding guidelines located in the front of your ICD-9 book. It clearly states to code all documented conditions that coexist. Hence diabetes, hypertension, etc. I did not write the coding guidelines, I just follow them. From what I understand, it is only chronic conditions like diabetes, hypertension, active cancers, etc. You would not pick up say.. chronic headaches if the pt came in for an ingrown toenail.
    Last edited by eadun2000; 09-27-2010 at 05:12 PM.

  7. Default
    Quote Originally Posted by eadun2000 View Post
    Please read your coding guidelines located in the front of your ICD-9 book. It clearly states to code all documented conditions that coexist. Hence diabetes, hypertension, etc. I did not write the coding guidelines, I just follow them. From what I understand, it is only chronic conditions like diabetes, hypertension, active cancers, etc. You would not pick up say.. chronic headaches if the pt came in for an ingrown toenail.
    Actually, the complete sentence reads "Code all documented conditions that coexist at the time of the encounter/visit, AND REQUIRE OR AFFECT patient care treatment or management." How will a coder or any reviewer know whether the condition required or affected patient care or treatment during that encounter if its not documented. How can you make that assumption.

  8. #8
    Location
    Stuart, Florida
    Posts
    331
    Default
    I am unsure as to where to find the proof that you're looking for. I'm sorry. I did send another AAPC member, that uses the forums and is always great at supplying the official proof for her answers, a private message to try and get her input into this thread but unfortunately my message hasn't been read... or maybe she didn't feel like replying? Not sure.

    I can tell you that, for the company that I work for, we go through validation audits yearly. During these validation audits, they go through our charts and make sure that we are coding per cms guidelines. I can tell you that we have had money taken back because of the lack of chronic conditions being addressed for the time period being audited. The doctors were writing "History of COPD" "History of CHF" etc etc, or they were including the chronic conditions in the PMH portion of the note and they were note showing any current treatment or addressing these chronic conditions in any way. We've been told not to code unless there is documented management of the condition, even if it is chronic. Each note stands alone, this we know. As coders, we are never to assume. When I first started coding, I argued that, as a chronic condition, we know that it is going to be an ongoing DX. I was told by an auditor, "How do you know they haven't had a miraculous recovery?" As stupid as that sounds to me, I don't make the rules... I just follow them.
    Vanessa Mier, CPC

  9. #9
    Location
    North Carolina
    Posts
    3,126
    Default
    I'm not sure if this is what you're looking for...

    Rules for reporting diagnosis codes on the claim are:

    -Use the ICD-9-CM code that describes the patient's diagnosis, symptom, complaint, condition or problem. Do not code suspected diagnosis.

    -Use the ICD-9-CM code that is chiefly responsible for the item or service provided.
    Assign codes to the highest level of specificity. Use the fourth and fifth digits where applicable.

    -Code a chronic condition as often as applicable to the patient's treatment.

    -Code all documented conditions that coexist at the time of the visit that require or affect patient care or treatment. (Do not code conditions that no longer exist.)


    http://www.cms.gov/manuals/downloads/clm104c23.pdf

  10. #10
    Location
    Sioux Falls South Dakota
    Posts
    358
    Default
    I was one of those who received the private message and sorry, I wasn't on the forums this morning, so just read it. I agree with Rebecca - I was going to direct everyone to the Coding Guidelines also.
    Lucinda (Cindy) McGarry, CPC-P
    Applications Specialist
    Avera Health Plans
    Education Office Sioux Falls SD Local Chapter
    Past President Sioux Falls SD Local Chapter

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