Health Information Management

Q&A: Sequencing additional diagnosis codes

JustCoding News: Outpatient, October 17, 2012

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QUESTION: I work for a gastrointestinal (GI) practice and I have a question regarding the correct sequence foradding diagnosis codes to a claim.

I have advised our physicians and billers that the primary diagnosis code is always the reason for the visit. I am a little confused about the remaining diagnosis codes the physician will write down in no specific order. Billers will report codes in the order the physicians write down the diagnoses and not always the reason for the visit.   For example, a patient is referred for a consult due to weight loss. The patient comes for the consult and the physicians may put down 787.29 (other dysphagia), 401.1 (benign hypertension), 783.21 (abnormal loss of weight), 787.99 (change in bowel habits) in this order and leave it up to the person entering the info to figure it out. 
I would report 783.21 first since that was the reason for the visit but then I’ve been putting the GI codes next and then anything else last. 
What is the correct sequence when adding diagnosis codes to a claim?
ANSWER: You are correct, the first-listed code should be the main reason for the visit, however, many times in a physician’s office, there are several issues prompting the visit.
Based on the information provided here, 783.21 is the issue that prompted the visit, so this should be reported first. Then, 787.29 and 787.99 should follow with 401.1 as the last reported code.
Editor’s note: Shelley C. Safian, PhD, MAOM/HSM, CCS-P, CPC-H, CHA, of Safian Communications Services in Orlando, Fla., answered this question. She is a senior assistant professor who teaches medical billing and insurance coding at Herzing University Online in Milwaukee, Wis. Email her at
This answer was provided based on limited information submitted to JustCoding. Be sure to review all documentation specific to your own individual scenario before determining appropriate code assignment.
Need expert coding advice? Submit your question to Senior Managing Editor Michelle Leppert, CPC, at, and we’ll do our best to get an answer for you.

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