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Thread: symptom confusion

  1. #1

    Default symptom confusion

    AAPC: Back to School
    Some confusion on this:

    Patient admitted through the ER in sickle cell pain crisis. In the notes the doc noted GERD, hemorrhoids, asthma and priapism. The priapism is a symptom of sickle cell crisis, so my first inclination was not to code it, but I'm told that's incorrect, and it should be coded.

    Now, I thought symptoms were only coded in this situation when the patient mentions them as a primary complaint. (Here the primary complaint was severe lower back pain.) Another example: pleural effusion is not coded when CHF is present on admission.

    Can anybody clarify this for me? Where would I find documentation on the fact that pleural effusion is a symptom of CHF and shouldn't be coded?

    Thanks for any help you might be able to provide.
    Last edited by greenery; 05-18-2011 at 06:56 PM. Reason: typo

  2. #2
    Join Date
    Apr 2007
    New Delhi, India

    Default Diagnosis help


    I believe as per coding guidelines, we should not code signs and symptoms (S&S) along with a code of disease responsible for those S&S, but if we have a proper diagnosis with the responsible disease, that should be coded as 'Code first' scenario. Here in the given example, priapism should be coded as it is a proper disease in itself, but it should be coded after sickle cell crisis as primary dx. In example of pleural effusion, it is considered a S&S, therefore should not be coded if clearly documented as a result of CHF.

    It's my opinion, others' advice is welcome.
    Girish Dadhich, CPC

  3. #3
    Join Date
    Apr 2007


    I agree with the previous post to your question. You can also find your answer in the ICD-9 book in the guideline section I.B.6 which is found on page 7.
    Catrina Jacobs, RCC, CPC

  4. #4


    delayed thanks to both of you, especially for the exact reference to the guidelines which I somehow overlooked

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