# Help with "rule out" ICD 9 codes



## bill2doc

My Dr diag is "rule out CVA"  Anyone have an icd9 suggestion for that?

Thank you !


----------



## mitchellde

You may not code rule out unless you are working for the inpatient facility.  You must code the symptoms documented.


----------



## Walker22

agree


----------



## bill2doc

Physician is seeing patient "in patient" at the hospital.  He is a contracted physician and needs to bill for professional services.  Hopsital will bill for facility services.  Are you saying that unless it is the hospital billing out the charges than it cannot be done?  He is seeing the patient under a 99232 so if the above is what I understand, I should code the symptoms the patient is experiencing... correct???  Thanks so much!


----------



## mitchellde

yes you are correct the facility coder may code rule out as if it exists nowever the physician coder may not so you will code the symptoms.


----------



## keke74

Hello, I agree with the previous responses. I am a Physician Coder and rule outs are not coded, you must code symptoms documented.


----------



## vj_tiwari

Agreed with above posts.

Just go thro' the symptoms mentioned. I think, these are weakness, slurred speech etc.

hope this helps.


----------



## priscilla1974

Very helpful


----------



## marsan72

*rule out*

If the signs and symptoms are "rule out hydronephrosis" and the findings are for ascites, can I code the ascite or would I need to get the actual signs/symptoms?


----------



## mitchellde

code the finding


----------



## TamaraM

in response to: "If the signs and symptoms are "rule out hydronephrosis" and the findings are for ascites, can I code the ascite or would I need to get the actual signs/symptoms?"


I would code primarily what test was order for-- if r/o hydronephrosis & and test is neg. then code the symptoms-- then code unrelated findings. If the finding is related to the reason the test was ordered, then the finding can be the primary dx code.


----------



## norrisnab1

*R/o dvt*

What code would you use for r/o dvt?


----------



## cordelia

Do they have edema? swelling? pain?


----------



## mitchellde

norrisnab1 said:


> What code would you use for r/o dvt?



You must code the presenting symptoms.  You cannot code a rule out diagnosis unless you are a facility coder coding for inpatient.


----------



## donnajrichmond

norrisnab1 said:


> What code would you use for r/o dvt?



As they've said if you are billing for a physician you must go back and look for/ask for the symptoms - what prompted the doctor to think there might be DVT? 
Uncertain diagnoses cannot be coded for physician or out-patient hospital claims- this includes r/o, consistent with, compatible with, possible, differential, suggests, etc.


----------

