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subsequent visit primary diagnosis code

  1. #1
    Default subsequent visit primary diagnosis code
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    Question for auditors: if the primary diagnosis code in the medical record doesn't match the primary diagnosis submitted on a claim form, would you count this as an error?

    What about if the primary ICD code on the claim form is the fourth ICD code listed in the medical record......would you count as an error?
    Dawnelle Beall, CPC, CPMA, CPC-I
    Licensed AAPC PMCC Instructor
    AAPC ICD-10CM Certified Trainer
    Previous AAPC Local Chapter President & VP

  2. #2
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    the listing in the medical record is not necessarily what determins the primary dx code. The documentation in conjunction with coding guidelines will be the determining factor for the dx codes and the order they go on the chart.

    Debra A. Mitchell, MSPH, CPC-H

  3. #3
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    I should have clarified this. Excluding coding convention scenarios, shouldnt the first listed diagnosis code in the medical record be listed first on the claim form??
    Dawnelle Beall, CPC, CPMA, CPC-I
    Licensed AAPC PMCC Instructor
    AAPC ICD-10CM Certified Trainer
    Previous AAPC Local Chapter President & VP

  4. #4
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    I am still unclear as to the issue, the primary dx is to be the primary dx treated or addressed during the encounter. If multiple conditions are treated then the most acute is the primary. Are you referring to the providers listing of diagnosis at the end of the record? if so then no the primary on the claim does not have to match what the provider lists as the number 1.

    Debra A. Mitchell, MSPH, CPC-H

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