Health Information Management

Tip: Appropriately sequence additional diagnoses

APCs Insider, January 11, 2013

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Determining the appropriate order to translate diagnoses into ICD-9 codes on the claim form can be challenging to say the least. To ensure proper sequencing of codes and correlation with the ultimate E/M code assignment, take a methodical approach to reviewing the documentation and determining the most clinically relevant diagnoses to the patient encounter.

A reasonable way to do this is to focus on the patient's chief complaint-what truly brought the patient into the office. Identify what patient complaints or problems were addressed by the physician through the history, physical exam, assessment, and plans for further workup or management.
For ­example, a patient comes in for a consult at a gastrointestinal practice due to weight loss.
The physician puts down 787.29 (other dysphagia), 401.1 (benign hypertension), 783.21 (abnormal loss of weight), and 787.99 (change in bowel habits) in that order.
If the consulting physician does not arrive at a more definitive ­diagnosis (or diagnoses) to explain the weight loss, the proper assignment and sequence of diagnoses on the claim are as follows:
  • Weight loss (783.21)
  • Dysphagia (787.29)
  • Change in bowel habits (787.99)
Unless the physician actively incorporates the hypertension into the patient's workup, you should omit code 401.1.
To properly assign and sequence ICD-9 codes on the claim form, focus on what clinical condition or conditions are being evaluated, ­managed, and addressed as part of the patient encounter. Always determine the patient's chief complaint and the physician's clinical assessment and plan for further workup and management. All other clinical conditions that are not relevant to the patient's current encounter should be considered on the lower end of the spectrum in terms of correct sequencing of diagnoses
The tip is adapted from “This month's coding Q&A” in the January Briefings on APCs.

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