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NKDA - How are others counting?

  1. Default NKDA - How are others counting?
    Medical Coding Books
    I would be interested in finding out how fellow coders are currently counting the NKDA? Is this a ROS or counted as a PFSH?

    Any input would be appreciated along with the rationale for the choice.

    Kurt Rego, CPC
    Corporate Compliance

  2. #2
    Default
    I was told at a Medicare seminar by the nurse reviewers that NKDA should be counted under PFSH. What do others do.

    roxanne

  3. #3
    Location
    Kansas City, MO
    Posts
    751
    Default NKDA - How are others counting?
    It should be counted in PFSH.

  4. #4
    Location
    Northeast Kansas (NEKAAPC)
    Posts
    692
    Default
    I think it depends on how your medicare carrier views it. We use it under ROS or PFSH but not both places.
    Brenda Edwards, CPC, CDEO, CPB, CPMA, CPC-I, CEMC, CRC
    AAPC Fellow
    AAPC ICD-10-CM/PCS Training Expert


    Kindness is contagious-PASS IT ON!

  5. #5
    Default
    I generally count this as an element of the ROS. If you look under medicare E/M guidelines it shows "allergic/immunologic" as a system - I perceive this as a general statement that can apply to any allergy reviewed. Allergies (unless otherwise stated) are a current issue for the patient - and can potentially affect the doc's treatment options.
    Jason Steeprow, CPC

  6. #6
    Location
    Louisville, KY
    Posts
    1,101
    Default
    CMS has made documentation guidelines for this relatively clear--where I (personally) find dissent is in the interpretation of presenters, auditors and educators.

    According to CMS, it may be counted as either Past Med. Hx. or as a ROS (All/Imm), but only one of those. It is pretty standard for auditors/coders to just automatically slam it into PFSH, although it may be needed elsewhere (e.g., ROS). Since the allowance is permitted by CMS, I would say it needs to be counted where it is needed in the document.

    If specific FIs have rules outside those of CMS, they should place those in writing. I would also pay heed to what the Medical Reviewers (not Clinical Reviewers) are stating from those FIs; these are the people reviewing your documentation, after all.

    Hope this helps.
    Kevin B. Shields, MA, RHIT, CPCO, CCS, CPC, COC, CCS-P, CPC-P, CPC-I

  7. #7
    Default Ros
    I, personally, consider NKDA a ROS (allergy). Typically, past history is easy to get anywhere else and it's another point in the provider's favor to use it as a system.

  8. Default
    NKDA stands for no known DRUG allergies. My outside consultant said that it should be counted as PFSH over ROS for 2 reasons: 1: it is documented (in my clinic) by the MA's not the provider and 2: it is not generally specific to the particular problem the patient is coming in for.

  9. Default
    I always count it in ROS. In the ED, where I code, I feel it is always pertinent to nature of the presenting problem.

    JG

  10. #10
    Location
    Cactus Wren
    Posts
    14
    Default Nkda
    This is part of the past medical history.

    If a patient is asked about other allergies such as environmental allergies like hay fever, this would be part of the ROS.

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