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


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

  4. #4
    Northeast Kansas (NEKAAPC)
    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
    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.

  6. #6
    Louisville, KY
    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.

  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.
    Belinda S. Frisch, CPC, CEMC
    Author of "Correct Coding for Medicare, Compliance, and Reimbursement"

  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.


  10. #10
    Cactus Wren
    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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