Everyone loves to read the general guidelines at the front of the ICD-10 book, right? No? Well, here’s an excerpt.
“Code all documented conditions, which coexist at the time of the visit that require or affect patient care or treatment. (Do not code conditions, which no longer exist).”
Most of the articles I’ve written have focused on the first sentence in this guideline. This article will focus on the second.
“Do not code conditions which no longer exist.”
That sounds fairly straightforward, doesn’t it? If the patient had appendicitis and a surgeon removed the appendix, then the patient no longer has appendicitis. If the patient had an ankle fracture four years ago and is seen today, the patient no longer has an ankle fracture. These examples are straightforward.
There is more confusion in selecting codes for cancer surveillance visits or for patients who have had a stroke or a transient ischemic attack (TIA). In the case of stroke, selecting the incorrect code raises the risk score for that patient and for the physician’s panel of patients. Since future payments in risk contracts are based on acuity, incorrectly reporting these conditions is a compliance issue.
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