# Out patient coding and UHDDS



## Lkimsey (Jul 3, 2007)

We are having a discussion about the difference in out patient coding using the UHDDS guidelines instead of the out patient guidelines in the November 15
2006 ICD-9-CM Official Guidleines for Coding and Reporting.
We are being told that the first listed diagnosis is the condition on admission and not the reason for the admission.  For example, a patient with remote history of CAD (1991) presents for a heart cath due to "chest discomfort".  The physician states that progression of the CAD could not be ruled out but did not come right out and say this was a progression.  The diagnosis listed first by the physician is Angina Pectoris with remote history of CAD.  One coder says the angina come first and the auditor, quoting inpatient rules, says the CAD goes first.  Can anyone help us with this?  
Thanks, Bewildered Coder


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## kevbshields (Jul 3, 2007)

As for IP Guidelines, UHDDS and this situation, actually it is Coding Clinic that says to sequence CAD before the Angina.  To my knowledge, that doesn't have anything to do with whether it is OP or IP.  Likewise, it would largely depend on the services as to what you're coding.  Remember, in OP environments, each encounter (and document) must stand on its own.  

Occasionally you may get an Observation note that requires one diagnosis and a surgery by the same physician (later along) that says something more specific.

I'm not sure this helps, but it doesn't seem to me the auditor is using IP guidelines, because I've read this recommendation in Coding Clinic:  CAD is listed first.

In relation to the Heart cath, shouldn't that be reported with the post-procedural diagnoses, regardless of the presenting?

Good luck.


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## Lkimsey (Jul 6, 2007)

Thanks Kevin, I am relatively new at coding OP so I was just confused.  L


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