# Using versus diagnosis on an inpatient hospital chart



## cpccoder2008 (May 3, 2012)

I am one of the inpatient coders for my local hospital and we are having a debate on whether or not you can use Versus diagnosis. Example,, we have a 1 year old who came in with fever and thigh/ leg pain. The thigh is swollen and very hard to touch. Our ortho doctor was consulted and ordered a MRI but we are unable to perform it at our hospital so the patient was transferred to a childrens hospital near by. The patient was admitted for one day before being transferred. On the discharge summary the final diagnosis is R/O deep abcess, R/O osteomylelits vs Septic Joint vs Pyomyositis. I can query the physician as we have done many times before but since the patient was only in house for one day chances are the doctor was never able to come to a final diagnosis which is why they put Versus. My question is how do we code this chart ? Do we pick the higher DRG since inpatient guidleines state that if a diagnosis is suspected you treat it as if it exsisted or do we pick the signs and symptoms ? I say we should pick the higher DRG since the physician treated the patient for all diagnosis and at the time of discharge was still unable to determine the appropriate one, however, my co worker disagree's and feels we should only code the signs and symptoms because the inpatient coding guidelines is no clear on how to code Versus it only talks about suspected diagnosis. Any feedback would be appreciated.

thanks


----------



## JWash618 (May 3, 2012)

In school we were always taught to NEVER code suspected, or rule-out diagnoses. I've been in the same office for almost two years and it is also a rule we all have here as well. If we get a Rule Out or Suspected DX, we either send it back for a better dx or code the signs and symptoms.


----------



## dltdavis (May 3, 2012)

outpatient does not code for Rule out, suspected But inpatient coders can dx the r/u or suspected.  I am not sure for the finaly dx but what was the patient admitted for.  Isnt it the admitting dx can also be the d/c dx if there is not anything else?


----------



## cpccoder2008 (May 4, 2012)

Yes this is inpatient so our guidelines are different and we can code suspected, i just wasn't sure of Versus. The patient was admitted for fever, thigh pain and high WBC which is why the physician suspected septic joint but after further testing and an Ortho consult he documented R/O deep abcess, R/O osteomylelits vs Septic Joint vs Pyomyositis. Without a MRI he was unable to tell the final diagnosis so they transferred the patient. My coding supervisor told me to code the fever as prinicple with the thigh pain as secondary and then code osteomylelits, Septic Joint and Pyomyositis as secondary as well but i don't agree with that.


----------



## mitchellde (May 4, 2012)

The guidelines state for inpatient and a versus dx you code both the this dx and the versus that dx


----------



## cordelia (May 4, 2012)

I am an inpatient coder and I agree with Debra, in the coding guidelines it states that if there is a vs, we are to code both conditions. 

Cordelia, CCS, CPC


----------



## cpccoder2008 (May 4, 2012)

So would i be correct to code all of them and pick the one with the highest DRG ?


----------



## cpccoder2008 (May 4, 2012)

mitchellde said:


> The guidelines state for inpatient and a versus dx you code both the this dx and the versus that dx



Thank you, i agree but we have a disagreement within our office.


----------



## narreshD (May 16, 2015)

as per UHDDS, if  physician says final Dx with versus conditions we have to code symptom followed by versus conditions as additional dx, please suggest if iam wrong


----------

