Diagnosis Coding: Your Top Diagnosis Coding Questions Answered

James Smith
June 7, 2012 — 1,473 views  
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Even though your practice is most likely getting ready for the ICD-10 transition, you possibly still have diagnosis coding questions that can't wait until 2014--or beyond--before you get answers. Here are the most pressing medical billing and coding questions with the solutions that can help you keep reimbursement flowing.

Don't Armchair Diagnose Patients

Question 1: In case the physician hasn't indicated ECG results in his final diagnosis, should you code the findings? The doctor wrote a thorough interpretation on the strip. He says "yes," as generally he has a different diagnosis to validate the ECG.

Answer 1: For you to report positive outcomes from the ECG, the physician certainly should document the findings as a final diagnosis. Selecting a diagnosis based on the patient's test results -- even when that diagnosis seems obvious-- is incorrect and probably fraudulent coding. CMS defines its guidelines for this issue in Transmittal AB-01-144 in which the agency maintains that a physician should definitely confirm a diagnosis based on the test results.

Here's why: The physician may specify that the ECG indicates an arrhythmia--however in case you base your coding on that statement and thenreport an ICD-9 code for unspecified arrhythmia, you may not be correct. The doctor may essentially have diagnosed the patient with a specific condition, for instance Wolff-Parkinson-White syndrome, which would be the accurate diagnosis code to report.

'V' Codes Can Be Primary, But May Not Be Payable

Question 2: Can you use 'V' codes as primary diagnoses?

Answer 2: Yes, you can use the 'V' codes as primary diagnoses, however whether or not you will collect reimbursement for these claims is entirely a different story.

V codes are frequently the answer in difficult-to-code scenarios but the challenge is deciding which V codes payers will accept and which they will reject. Frequently, payer edits are not published anywhere, and all coders and billers can do is to collect the list of payable and non-payable V codes from their claim experience.

Look to Documentation--Not LCD--for WTM Dx Code

Question 3: Which diagnosis code must be reported with the Welcome to Medicare (WTM) exam and the annual wellness visit (AWV)?

Answer 3: CMS does not dictate which ICD-9 code must be linked to the WTM exam code (G0402, Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of Medicare enrollment). Instead, you must select the most applicable diagnosis code from your physician's documentation.

"An instance of diagnosis codes that could be included on the WTM claim are V70.0 (Routine general medical examination at a health care facility), V70.3 (Other general medical examination for administrative purposes), or V70.9 (Unspecified general medical examination).

Determine How Many Dx Codes to Report

Question 4: Your doctor treated a patient with diabetes, however he was actually seeing the patient for treating a complication of the diabetes, diabetic neuropathy. In his evaluation, the physician also found that the patient had joint inflammation. Should you report the neuropathy complication only, or several of the ICD-9 codes?

Answer 4: Usually, the primary diagnosis code that you actually list on your claim must represent the chief reason for the encounter, or the situation with the maximum risk of morbidity/mortality that the physician addresses during the visit. The situation alters, though, when you deal with a situation like diabetes. (As per Section 1.A.6 of the ICD-9-CM Official Guidelines for Coding and Reporting, "Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology. For such conditions, the ICD-9-CM has a coding convention that requires the underlying condition be sequenced first followed by the manifestation.")

The Guidelines continue, clarifying that you may report more than one code from category 250 to fully define the patient's complete diabetic condition in case the patient has more than one manifestation of diabetes.

Therefore, you must first report ICD-9 code 250.6x (Diabetes with neurological manifestations) on the claim. Don't forget to add a fifth digit to reflect the type of diabetes the patient has.

Your secondary code must represent the specific neurological manifestation. In most cases, you will report ICD-9 code 357.2 (Polyneuropathy in diabetes).As the doctor documented that the patient also has joint inflammation, you must report the correct code defining that condition (716.9x, Arthropathy, unspecified).



James Smith

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