Results 1 to 5 of 5

Outpatient diagnosis question

  1. #1
    Default Outpatient diagnosis question
    Medical Coding Books
    When an ED physician uses the verbage "most likely represents ..." would this be considered like a probable and not codeable--outpatient rules. Physician documented his Diagnosis--Allergic reaction. Physician documented in his Plan--considerations for the reaction could be due to some plums the patient had eaten or most likely due to patient's medication. I coded as allergic reaction, nos--995.3, since physician did not know for sure what the patient was allergic to. An auditor coded as adverse effect of correct medicinal substance properly administered--995.29 plus E code.

  2. #2
    Duluth, Minnesota
    I would have coded it as you did - nothing was definite, how could the auditor basically "assume" it was due to the medicine taken correctly, when it could have been from the plums eaten?.... it might have more "more than likely" that it was the meds, but it wasn't definitive.... I agree with you, and I'd argue the point with the auditor (though, we know it wouldn't do any good)

    {that's my opinion on the posted matter}
    Donna, CPC, CPC-H

  3. Default
    I am an auditor and would have coded as you did. Never code the uncertain or probable. The provider was equally as uncertain if the reaction was due to plums or medication. I would have used 995.3 and then an unspecified E code. GOOD JOB!
    ~Amy, CPC, CPMA, CEMC~

  4. Default
    I too, would have coded the exact same way you did. Right from the written out-patient coding guidelines and I would copy them and attach to the finding.

  5. Default code 995.3
    It seems the doctor documented the final dx as Allergic reaction.
    cause uknown..then it should be coded as is.
    if you code more than whats specified then you're assuming...coders/auditor cannot assume...we can only query.

Similar Threads

  1. outpatient coding for diagnosis vs diagnosis
    By rkeia32 in forum Resume Postings
    Replies: 1
    Last Post: 07-11-2015, 07:44 PM
  2. Outpatient Therapy diagnosis coding
    By flaw in forum Pediatrics
    Replies: 0
    Last Post: 03-30-2012, 05:39 AM
  3. outpatient lab diagnosis from scripts
    By weina in forum Medical Coding General Discussion
    Replies: 0
    Last Post: 07-08-2010, 05:09 AM
  4. Admitting diagnosis, outpatient
    By FTessaBartels in forum Emergency Department
    Replies: 0
    Last Post: 03-11-2010, 02:30 PM
  5. outpatient surgery first diagnosis code
    By territheriot in forum Diagnosis Coding
    Replies: 1
    Last Post: 05-08-2009, 12:26 PM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?


Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.