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Dx coding for Gastroparesis and Anorexia

  1. #1
    Smile Dx coding for Gastroparesis and Anorexia
    Medical Coding Books
    I have a Doctor's Impression statement that reads, "Anorexia and Gastropareis." And Gastroparesis can be a cause of Anorexia. So is the "and" enough to Code First the Anorexia then the Gastropareis? Or, do we code them completely separate?

  2. #2
    Default
    I'd code them separately - Gastroparesis can also be caused by diabetes, so the etiology of Anorexia should be primary. I wouldn't read too much into the "and" - I think the doctor's just saying that the patient has both. I would think the order of the conditions says something, though. The doctor listing Anorexia first tells me that he considers it the main issue. I might be wrong about that, though - a good way to check is to see if the note indicates anorexia, or anorexia nervosa. If it is anorexia nervosa, then it's a safe bet that it's the etiology, not the manifestation. If not, then you'll have to rely on the body of the note to give you context clues as to whether the chicken or the egg came first.

  3. Default
    Anorexia nervosa is one of the underlying causes of gastroparesis (delayed emptying of the stomach due to a sort of vagus paralysis or paresis for which one reason being anorexia nervosa. The codes i would assign are 307.1, 536.3.
    There is yet another anorexia (plain) which is just loss of appetite(783.0). Since your doctor documented "anorexia" alone you could very well clarify with him or her.
    But the syndrome associated with gastroparisis is Anorexia nervosa.

  4. #4
    Default dx coding for gastroparesis
    THanks, I think that I came up with the same thing....

    Do you remember the EKG encounter we discussed for a while? I think that I have the answer.
    I am going with a 99214 (no modifier) plus 93000 (difficult choice), and both are linked to 786.50 and V45.82, which post RCA and and stent(actually a PTCA or V45.82). It is perfect.

    My questions are can I used the V45.82 in my part A of the MDM? And any other feedback?

  5. #5
    Default
    I don't think the V-Code fits in with the MDM. The doctor makes it pretty clear that he doesn't think they're related, with the word "noncardiac" describing the chest pain. So I wouldn't take it into consideration for the current diagnosis or treatment options, and the note's not really clear that the doctor ordered or reviewed old record records relevant to the V-code's description (such as the surgical note from the stent); only the past chest x-ray, if I remember correctly (which is really non-specific). The past cardiac conditions are ruled out of the risk portion, also, because the current exam shows no indication of current cardiac complications, so I'd think factoring either in the MDM is really a stretch. At this point, they're more informative than problem-pertinent.

  6. #6
    Default V45.82
    You are right about the non-cardiac pain statement. But the statement was "suspect this is non-cardiac pain, probably chest wall." The dr. recommended Darvocet, which is a risky pain reliever. However, he also Rx'd Nitroglycerin. He also did an EKG.

    Also, the patient also had a brother that died of an MI. You may be right here, but why the Nitro?

  7. #7
    Default dx coding for gastroparesis
    Preserene -- I am a remote coder, so I can not ask anyone. Wish I could. The Anorexia Nervosa dx code, first, would make more sense, but the doctor only mentioned Anorexia. So my only choice is to code Anorexia then Gastroparesis.

  8. #8
    Smile V45.82
    Also, the doctor's office originally coded a 414.01, which is RCA. The V45.82 just means that she had PTCA in the past. So, I don't know, but I am going to sleep on it.

  9. Default
    Hi Fred, I am sorry.
    Well in that case you are right, when doctor did not document we cannot assume the diagnosis.
    But for indepth insight and for relevance of the scenario, I just jot down some points here:
    anorexia= Loss of appetite, especially as a result of disease. This could be temporary or a chronic illness an dto my knowledge this does not land up with neuronal entity , like gastroparesis
    Anorexia nervosa= is usually a teenager's self inflicted disorder- an eating disorder characterized by refusal to maintain a healthy body weight and an obsessive fear of gaining weight, admixed with cognitive biases] Persons with anorexia nervosa continue to feel hunger, but deny themselves all but very small quantities of food. The average caloric intake of a person with anorexia nervosa is 600-800 calories per day, but in extreme cases self-starvation is more extreme.It is a serious mental illness with a high incidence of comorbidity .It is this type of anorexa nervosa which causes gastroparesis.
    Anorexia nervosa is the one which is attributed to gastroparesis always and it merits for primary diagnosis.
    But anorexia as such (illdefined) ,would it merit for prim diagnosis (when there is yet another diagnosis available)?
    If there are more info about age, symptoms, past history ,signs available, you can be sure of.
    It is so hard, sometimes the doctors make us rack our head!!!

  10. Default
    Quote Originally Posted by fredcpc View Post
    You are right about the non-cardiac pain statement. But the statement was "suspect this is non-cardiac pain, probably chest wall." The dr. recommended Darvocet, which is a risky pain reliever. However, he also Rx'd Nitroglycerin. He also did an EKG.

    Also, the patient also had a brother that died of an MI. You may be right here, but why the Nitro?
    The probability, suspecious sort of diagnosis still do not rule out the opposite conditions-here it still do not rule out the cardiac pain too; And all the more when there is a strong sibling history of MI and the medical necessity to prescribe Nitro by the doctor- means he wants to rule out unstable angina, angina pectoris still ; if the pain still not relieved with nitro, doctor cannot rule out cardiac like MI

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