# Coding Co-Morbid Conditions



## Ltoth (May 28, 2009)

We are wondering if you audit a chart for say bronchitis but the patient also has one or all of the following listed in the PAST HX. if you use it as well.  The dx. being..... hypertension, diabetes, Parkinson's, COPD, etc.  We are not using them if the provider is not addressing them but are now questioning ourselves.

Thank you for your help.
Lisa


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## rthames052006 (May 28, 2009)

Ltoth said:


> We are wondering if you audit a chart for say bronchitis but the patient also has one or all of the following listed in the PAST HX. if you use it as well.  The dx. being..... hypertension, diabetes, Parkinson's, COPD, etc.  We are not using them if the provider is not addressing them but are now questioning ourselves.
> 
> Thank you for your help.
> Lisa



In our office we don't list them either, unless they are being addressed.  Alot of times we see the "laundry" list of ailments but if they have no effect on treatment of the current condition and are just mentioned in past history then no we don't count them.


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## LTibbetts (May 28, 2009)

Here, we do use all of the dx's. That is mostly for our ER charts, though. We sometimes need them for additonal labs & tests done while the patient was here. We also use all dx's listed on the superbill for our clinic visits. Also, it states in the guidelines (on page 90) to "list additional codes that describe any coexisting conditions. In some cases the first-listed diagnosis may be a symptom when a diagnosis has not been established by the physician." Hope this helps. I think everyone codes a little different and other people tend to interpret things different ways so this is just my opinion and my way of coding.


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## Lisa Bledsoe (May 28, 2009)

I agree with Roxanne.  I only code the current conditions addressed, not from the history or chronic conditions list.


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## LLovett (May 28, 2009)

Most times it won't make a difference in the E/M level since you have a new problem that will require rx management. But you need to keep in mind that even though they aren't addressing the HTN, DM, etc directly, if the patient is on meds for chronic conditions they have to take those in consideration before they can write another script. So even though they may not be focusing on  the HTN today, they are still dealing with it.

Just my thoughts,

Laura, CPC


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## Karolina (May 28, 2009)

Sometimes underlying conditions do influence decisions - as stated in Laura's example  - and in such cases I do count those. If they don't have an impact, I would not count them. I would credit Past History and also consider all the conditions the patient has to deal with when looking at the table of risk. Even if the provider is not currently actively dealing with the issue(s), it still adds to the risk for the patient.
Karolina, CPC


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## rthames052006 (May 28, 2009)

Karolina said:


> Sometimes underlying conditions do influence decisions - as stated in Laura's example  - and in such cases I do count those. If they don't have an impact, I would not count them. I would credit Past History and also consider all the conditions the patient has to deal with when looking at the table of risk. Even if the provider is not currently actively dealing with the issue(s), it still adds to the risk for the patient.
> Karolina, CPC



I do understand your point of view on this topic I guess I am  used to my physicians listing those types of conditions elsewhere not only in past history. My docs will list them w/ the a/p part of the note, not just in the Past history.


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## Karolina (May 28, 2009)

*to rthames052006*

I agree with that, mine do to. In the given example it seemed limited to the past hx. Thanks!


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## rthames052006 (May 28, 2009)

Karolina said:


> I agree with that, mine do to. In the given example it seemed limited to the past hx. Thanks!



Karolina....

I'm glad we were on the same "wave length".


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## Ortizt (May 29, 2009)

We had to write a SOP to this effect to cover ourselves when outside auditors came in to review our records as part of our CBI plan. Some auditors would pick up the ALL chronic conditions while others limited the diagnoses to the A/P- which is what our SOP stuck with the provider's A/P documentation!!


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## Karolina (May 29, 2009)

If you do provider training on documenting you may want to encourage them to be thorough when documenting the problems they need to take into consideration and mention something in the A/P, e.g., pt. will receive reduced strength chemo due to underlying heart condition.


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## rachell1976 (Jun 1, 2009)

We do not use the list of DX history. Only those which will effect the way the patient is treated at the visit.

For Example, a patient with Epistaxis. If they also have Hypertention, anemia or coagulation defects, we always list those diagnosis since they are involved in decision making for this visit and current condition.


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## meganpoelzer (Jun 2, 2009)

Hi,

I think it's appropriate to list the diagnoses, but not to use them to increase MDM unless "...the record clearly demonstrates their presence increase physician work related to the enounter". If the physician listed the dx under A/P, and notes that they are managing their medications, etc., then it would be appropriate for the dx to increase the MDM.

Megan B, CPC


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