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Thread: Suspected Diagnosis

  1. #1

    Default Suspected Diagnosis

    AAPC: Back to School
    You guys are going to slap me on the hand today. My brain is stuck and is non-functioning I swear!!

    When you have a suspected or rule out dx, and the findings after biopsy are normal, do you code the suspected as if they actually had it when the patient is in the hospital? or do you code signs/symptoms?

    My patient here has suspected temporal arteritis ... well signs/symptoms were headaches and jaw claudication. After path, everything was normal.


  2. #2

    Smile Suspected Diagnosis

    Suspected and/or rule out codes are not allowed in the coding field. You would need to code signs and symtoms.
    I hope this helps

  3. #3


    The patient is in the hospital though .... the ICD9 guidelines state you can in long term or acute care hospitals when the diagnosis is unconfirmed at discharge. This is where I'm confused.. why would you discharge them if it were unconfirmed? lol.

  4. #4
    Join Date
    Apr 2007
    Albany, New York


    Faye Brown Handbook states: When a diagnosis for an inpatient at the time of discharge is qualified as "possible", "probable, "suspected", "likely", "questionable", "?", or "rule out", the condition should be coded as though the diagnosos were established.
    Note that the exception to this guideline is the coding of HIV infection/ illness.
    This condition requires physician documentation that confirms the diagnosis.
    The guideline regarding unconfirmed diagnosis does not apply to coding or
    reporting for an outpatient (for those cases, the principal diagnosis is the highest degree of certainty susch as symptoms, signs or abnormalities).

    Karen Maloney, CPC
    Data Qaulity Specialist:

  5. #5


    I agree with the above poster. The biggest difference in inpatient and outpatient coding (at least from my perspective) is that in an inpatient setting you code for "rule out", etc. etc. diagnoses as if they actually exist. In an outpatient setting you have to have confirmation of diagnoses. I think it's a little hinky myself, but them's the rules!

  6. #6

    Default patti

    Could someone tell me how to code rule out seizures for a professional service. Thanks

  7. #7
    Join Date
    Apr 2007
    Columbia, MO


    Rule out cannot be coded by physician coders or outpatient facility coder. Only facility inpatient coders do code rule out but not physician coders in the inpatient setting.

    Debra A. Mitchell, MSPH, CPC-H

  8. #8

    Default Suspected conditions

    The guidelines state that you cannot code conditions that are "suspected", "rule out" or "probable". What are the guidelines regarding V02 codes: "Carrier or suspected carrier of infectious diseases".?

    Osmin O. Smalls, CPC, CGSC

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