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symptoms that are integral to the disease

  1. #1
    Location
    Salt Lake
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    10
    Default symptoms that are integral to the disease
    Medical Coding Books
    The coding guidelines state that "conditions that are integral to the disease process should not be assigned as additional codes". Does the documentation have to provide information that the symptom is part of the the disease, or is it ok leave off the codes for things I know to be symptoms of other disorders? For example, I would not code anxiety separate to a patient that was diagnosed with panic disorder. Also per the DSM-IV insomnia and other sleep issues are very common symptoms for multiple mental health disorders so unless the provider documents that insomnia is a separate condition I consider it a symptom of the bipolar or major depression. I frequently get arguements from the other coder I work with because she said she was trained to code them separately unless the doctor ties them to each other. I would love to get someone else's view point on this. Thanks.

  2. #2
    Location
    Tacoma, WA
    Posts
    1,087
    Default
    Quote Originally Posted by kdt930 View Post
    The coding guidelines state that "conditions that are integral to the disease process should not be assigned as additional codes". Does the documentation have to provide information that the symptom is part of the the disease, or is it ok leave off the codes for things I know to be symptoms of other disorders? For example, I would not code anxiety separate to a patient that was diagnosed with panic disorder. Also per the DSM-IV insomnia and other sleep issues are very common symptoms for multiple mental health disorders so unless the provider documents that insomnia is a separate condition I consider it a symptom of the bipolar or major depression. I frequently get arguements from the other coder I work with because she said she was trained to code them separately unless the doctor ties them to each other. I would love to get someone else's view point on this. Thanks.
    A simpler way of putting it would be - if the symptoms are always part of the disease you are coding, you do not code the symptoms separately. That would be like unbundling a procedure to all it's little parts. If the diagnosis is Influenza for example, you do not need to code the fever, body aches, runny nose, etc in addition to the influenza code. They are integral parts of the disease process.
    Arlene J. Smith, CPC, CPMA, CEMC, COBGC

  3. Default
    I agree with Arlene. If my provider's diagnose the pateint with bronchitis and cough, I don't code the cough. But if the doctor diagnoses the pateint with Diverticulitis and Abdominal Pain, I would code the abdominal pain because it could be due to something else as well as many of our patients have Diverticulitis and many other diagnosis. It sounds like Anxiety would be an intigral part of Panic Attacks, but you may want to quiery the physician about the Insomnia.

  4. #4
    Location
    Ellenville, New York
    Posts
    1,177
    Default Devils Advocate here
    While the responses posted are excellent and accurate, this may not always be cut and dried. A good one I see often is UTI's and then various urniary conditions, such as frequency or nocturia. Without documentation from the physician, should it just be assumed that these urinary issues, which are often symptoms of a UTI but not always the case, are a symptom of the UTI and left out or not?

    Lance Smith, MPA, COC, CPMA, CEMC, RHIT, CCS-P, CHC, CHPC

    Director, Health Information Management
    HealthAlliance of the Hudson Valley
    Kingston, NY


    2016 Secretary
    Ellenville, NY Local Chapter

  5. #5
    Location
    Everett, WA
    Posts
    886
    Default
    I'm glad the initial question was posted as it has always been a concern. Shouldn't there be in the documentation somewhere that the side effects are noted to be just that? This would make it so much easier and provide the safeguards from making any "clinical assumptions". Just typing that last sentence made me nervous, so I'd query the physician. ---Suzanne E. Byrum CPC

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