Results 1 to 4 of 4

Billable Dx without Treatment Plan?

  1. #1
    Location
    Overland Park, KS
    Posts
    1,166
    Default Billable Dx without Treatment Plan?
    Medical Coding Books
    This may sound like a dumb question, but can a provider bill a dx without a treatment plan? For example: A patient is seen and diagnosed with Dysuria, Otitis media and strep Pharyngitis. There is a plan of treatment documented for the pharyngitis (i.e. prescription meds, lab procedure results, etc), but nothing listed for the dysuria and OM. Are the billable?

    I'm pretty certain that the dx billed have to either be addressed or at least relevent to the encounter, but there is a provider questioning this.

    Any thoughts?
    Last edited by dballard2004; 12-17-2010 at 07:28 AM.
    Dawson Ballard, Jr., CPC, CEMC, CPMA, CCS-P, CPC-P, CRHC, AAPC Fellow
    Coder

  2. #2
    Location
    Overland Park, KS
    Posts
    1,166
    Default
    I am not trying to sound dumb here, I just need another take on this. Is there perhaps CMS guidance?
    Dawson Ballard, Jr., CPC, CEMC, CPMA, CCS-P, CPC-P, CRHC, AAPC Fellow
    Coder

  3. #3
    Location
    Columbia, MO
    Posts
    12,527
    Default
    There is no rule that I am aware of except that I have read, and it may be in the coding guideliens, that we code all additional dx as long as they are managed controlled or treated during the encounter. However in this scenario All of these conditions are acute, so all were investigated and the treatment is aimed at the pharyngitis, so perhaps by treating the one condition all others will resolve as well as the physngitis is determined most basic underlying concern. So since these are all acute conditions I would code them all. As opposed to if he also mentioned the patient had HTN, and CAD, neither were treated or addressed so we would not code them.

    Debra A. Mitchell, MSPH, CPC-H

  4. #4
    Location
    Overland Park, KS
    Posts
    1,166
    Default
    Thanks Debra! I appreciate it!
    Dawson Ballard, Jr., CPC, CEMC, CPMA, CCS-P, CPC-P, CRHC, AAPC Fellow
    Coder

Similar Threads

  1. Plan of Care & Physician Plan of Treatment
    By lmfort in forum Neurology/Neurosurgery
    Replies: 0
    Last Post: 08-13-2015, 11:45 AM
  2. Billable Dx W/O Treatment Plan?
    By dballard2004 in forum Medical Coding General Discussion
    Replies: 1
    Last Post: 12-17-2010, 01:22 PM
  3. Psychiatric Treatment Plan/Recovery Plan/Care of Plan
    By rnakahara in forum Employment General Discussion
    Replies: 1
    Last Post: 07-17-2009, 04:00 PM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •  
Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?

Login

Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.