Wiki G62.9 and E11.42

[kerenorozco]

Hello,
I am new to coding- recently graduated.
If my Dr. is giving me a G62.9- and in his comments he says is due to Diabetes- shouldn't I ask him to consider E11.42 instead?

Thank you

 

[sls314]

Hello,
I am new to coding- recently graduated.
If my Dr. is giving me a G62.9- and in his comments he says is due to Diabetes- shouldn't I ask him to consider E11.42 instead?

Thank you

Most physicians are not very knowledgeable about coding. He may not even be aware that a combination code exists. (Or may not care to document it separately.)

With documentation stating polyneuropathy due to diabetes, that would certainly be E11.42 (or E10.42 if the documentation showed T1D).

At my employer, I would make the change on the claim myself without consulting the physician. I code based on what's supported in the documentation and have the freedom to do so without running it by my physicians every time.

However, I know that not every office is like that. In some offices, coders feel like they can't change the numeric code the physician selected from the list, even if the language used in the documentation actually supports a different code. (I don't necessarily understand why a practice wouldn't allow a certified coder to utilize their expertise to ensure the correct code is being billed, but some offices are like that.)

I'd talk with your physician and clarify how he'd prefer you to handle this and similar future situations.

Would he rather you run it by him every time? Or would he rather you update to the correct code when the documentation states something as clear cut as "polyneuropathy due to diabetes"?

 

[kerenorozco]

Most physicians are not very knowledgeable about coding. He may not even be aware that a combination code exists. (Or may not care to document it separately.)

With documentation stating polyneuropathy due to diabetes, that would certainly be E11.42 (or E10.42 if the documentation showed T1D).

At my employer, I would make the change on the claim myself without consulting the physician. I code based on what's supported in the documentation and have the freedom to do so without running it by my physicians every time.

However, I know that not every office is like that. In some offices, coders feel like they can't change the numeric code the physician selected from the list, even if the language used in the documentation actually supports a different code. (I don't necessarily understand why a practice wouldn't allow a certified coder to utilize their expertise to ensure the correct code is being billed, but some offices are like that.)

I'd talk with your physician and clarify how he'd prefer you to handle this and similar future situations.

Would he rather you run it by him every time? Or would he rather you update to the correct code when the documentation states something as clear cut as "polyneuropathy due to diabetes"?

Thank you so much for your repornse.
Yes, since he is new as well it has been a little back and forth,
I have to ask before I make any changes since our facilities run a provider vs coder report, and we cannot change much on the physician notes.
Thank you !!

 

[sls314]

Thank you so much for your repornse.
Yes, since he is new as well it has been a little back and forth,
I have to ask before I make any changes since our facilities run a provider vs coder report, and we cannot change much on the physician notes.
Thank you !!

I would definitely just discuss it with him then. Use it as an opportunity to educate about the combination codes.

By the way, just to clarify, I don't change the provider's notes. On the claim, I use the correct diagnosis code based on the verbiage the provider stated in the note.

(To be honest, I'd prefer if my physicians used just the diagnostic verbiage and not try to state the actual diagnosis code. I know that's a pipe dream when most EHRs force providers to click and select a code. We have a locum who just states the diagnosis in words, and I assign all of his diagnosis codes. I love it when he covers for one of our doctors.)