Health Information Management

Q&A: Coding for comparative and contrasting diagnoses

JustCoding News: Inpatient, March 31, 2010

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QUESTION: Many coders at our facility code comparative and contrasting diagnoses differently. The coding guidelines about comparative and contrasting diagnoses reads:

In those rare instances when two or more contrasting or comparative diagnoses are documented as "either/or" (or similar terminology), they are coded as if the diagnoses were confirmed and the diagnoses are sequenced according to the circumstances of the admission. If no further determination can be made as to which diagnosis should be principal, either diagnosis may be sequenced first.

This statement only applies to inpatient coding, correct? If this were an outpatient admission, coders should just code the signs and symptoms?

ANSWER: Yes. This guideline comes from Section II, Part D, Two or more comparative or contrasting conditions from the ICD-9-CM Official Guidelines for Coding and Reporting. This guideline is for inpatient admission reporting.

For outpatient services, look at Section IV, Part I, Uncertain diagnosis, which states:

Do not code diagnoses documented as “probable”, “suspected”, “questionable”, “rule out”, or “working diagnosis” or other similar terms indicating uncertainty. Rather, code the condition(s) to the highest degree of certainty for that encounter/visit, such as symptoms, signs, abnormal test results, or other reason for the visit.

Note that a contrasting or comparative diagnostic statement indicates uncertainty as to which diagnosis is most accurate. Therefore, apply the guidance in Section IV, Part I when providing outpatient services.

Editor’s note: Shelley C. Safian, MAOM/HSM, CCS-P, CPC-H, CHA, of Safian Communications Services in Orlando, FL, answered this question. She is a senior assistant professor who teaches medical billing and insurance coding at Herzing University Online in Milwaukee, WI. E-mail her at ssafian@embarqmail.com.

This answer was provided based on limited information submitted to JustCoding.com. Be sure to review all documentation specific to your own individual scenario before determining appropriate code assignment.



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