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DX coding question, please

  1. #1
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    Default DX coding question, please
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    Pt presented with increased anxiety. Reasons documented are "sad mood" and "worrying a lot more." Pt also has GERD, and this was addressed with Nexium. Physician coded the anxiety as 293.84, stating that the patient was worried because she was having trouble with swallowing due to the GERD. I told the MD she needed to document the connection, and she wouldn't do so, stating "that's the only reason she could be worrying more." So, even if she does document this connection, does this really warrant using 293.84? I would believe that 300.00 would be more appropriate since the pt also has a long history of visits for her panic attacks. Not to mention that if we DID use 293.84, we would have to code the GERD first.

    Thoughts?

  2. #2
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    I would not use 293.84 without documentation of the relationship. It makes me wonder, if the doc really feels "that's the only reason she could be worrying more," then why will she not put that in writing?

    On a related note, if you did use 293.84, I don't thing the GERD would have to be first. Does 293.84 have a "code first" note? I don't have my book in front of me so I might be wrong.
    J G Stanley, MHA, CPC

  3. #3
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    it sounds more like a 799.2x code for the sadness and anexiety. these are codes in the chapter for signs and symptoms and not mental disease.

    Debra A. Mitchell, MSPH, CPC-H

  4. #4
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    Used 300.00 because the anxiety was documented, pt is also currently taking Zoloft. Felt that was sufficient to use the 300.00 instead of the S/S codes - but the combination code was my concern. And yes, if we did use the 293 category, the GERD would have to be coded first.

  5. #5
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    Quote Originally Posted by MnTwins29 View Post
    Used 300.00 because the anxiety was documented, pt is also currently taking Zoloft. Felt that was sufficient to use the 300.00 instead of the S/S codes - but the combination code was my concern. And yes, if we did use the 293 category, the GERD would have to be coded first.
    The problem is the 300.00 is a code withing the chapter of Mental disorders and the sub chapter NEUROTIC DISORDERS, PERSONALITY DISORDERS, AND OTHER NONPSYCHOTIC MENTAL DISORDERS (300-316)

    Even though the patient is on Zoloft does not mean they have a Mental disorder. I still think you should have gone with the 799.2x codes as they do not append a mental disease label on the patient and it does not look as though you physician penned that label either. Worried due to a medical condition does not to me indicate a mental disorder. Also the gerd should be coded first if it is the condition causing the anexiety. The guidelines state that if an underlying condition is documented as the cause or reason for the current condition then unless a chapter specific guidelines states otherwise we code the underlying condition first.

    Debra A. Mitchell, MSPH, CPC-H

  6. #6
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    Quote Originally Posted by mitchellde View Post
    The guidelines state that if an underlying condition is documented as the cause or reason for the current condition then unless a chapter specific guidelines states otherwise we code the underlying condition first.
    You are correct. I did not realize this was an "in conditions classified elsewhere" code.
    J G Stanley, MHA, CPC

  7. #7
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    Quote Originally Posted by mitchellde View Post
    The problem is the 300.00 is a code withing the chapter of Mental disorders and the sub chapter NEUROTIC DISORDERS, PERSONALITY DISORDERS, AND OTHER NONPSYCHOTIC MENTAL DISORDERS (300-316)

    Even though the patient is on Zoloft does not mean they have a Mental disorder. I still think you should have gone with the 799.2x codes as they do not append a mental disease label on the patient and it does not look as though you physician penned that label either. Worried due to a medical condition does not to me indicate a mental disorder. Also the gerd should be coded first if it is the condition causing the anexiety. The guidelines state that if an underlying condition is documented as the cause or reason for the current condition then unless a chapter specific guidelines states otherwise we code the underlying condition first.
    ...if she (doctor) DOCUMENTED that. It was only told to me when we reviewed the findings from my audit, hence why I questioned the 293 category. And for having the mental disease label "penned" on the patient - that had already been done in prior visits. I know you don't use those for the current visit, but she did have a long history of anxiety and panic attacks.

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