# symptom confusion



## greenery (May 18, 2011)

Some confusion on this:

 Patient admitted through the ER in sickle cell pain crisis. In the notes the doc noted GERD, hemorrhoids, asthma and priapism.  The priapism is a symptom of sickle cell crisis, so my first inclination was not to code it, but I'm told that's incorrect, and it should be coded. 

Now, I thought symptoms were only coded in this situation when the patient mentions them as a primary complaint. (Here the primary complaint was severe lower back pain.) Another example: pleural effusion is not coded when CHF is present on admission.  

Can anybody clarify this for me? Where would I find documentation on the fact that pleural effusion is a symptom of CHF and shouldn't be coded?

Thanks for any help you might be able to provide.


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## dadhich.girish (May 19, 2011)

*Diagnosis help*

Hi,

I believe as per coding guidelines, we should not code signs and symptoms (S&S) along with a code of disease responsible for those S&S, but if we have a proper diagnosis with the responsible disease, that should be coded as 'Code first' scenario.  Here in the given example, priapism should be coded as it is a proper disease in itself, but it should be coded after sickle cell crisis as primary dx.  In example of pleural effusion, it is considered a S&S, therefore should not be coded if clearly documented as a result of CHF.

It's my opinion, others' advice is welcome.


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## cjacobs (May 19, 2011)

I agree with the previous post to your question.  You can also find your answer in the ICD-9 book in the guideline section I.B.6 which is found on page 7.


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## greenery (May 23, 2011)

delayed thanks to both of you, especially for the exact reference to the guidelines which I somehow overlooked


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