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symptom confusion

  1. Default symptom confusion
    Medical Coding Books
    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
    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
    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. Default
    delayed thanks to both of you, especially for the exact reference to the guidelines which I somehow overlooked

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