# Rule out DX's



## Trendale (Aug 19, 2009)

Hello,
How do you determine when to code the rule out dx? I usually look at the medical decision making to see if any treatment for it will be done, and what they were reusted to do  but if that is the only DX given, I code it. This is pertaining to inpatient consults, I know you can code rule outs for inpatient, but not outpatient. Let me give you a quick scenario:

The doctor was asked to do a consult on a patient that has SOB, wheezing, exertional dyspnea.
The DX's listed are COPD, Acute bronchitis exacerbation, SOB, Rule out pulmonary embolism or cardiac cause.

The recommendations are: Wil continue current bronchodilators, including nebulization, advair, IV corticosteroids and current antibiotics with pneumonia protocol using rocephin and zithromax. Will check D- Dimer. if this is abnormal, we will plan to proceed with lower extremity venous dopplers as well as consideration for CT angiogram of the chest to rule out occult causes for her acute exacerbation.


So, since he may plan to do Venous Dopplers and CT angiogram of the chest to rule out causes for acute exacerbation, I did not know if I should code the rule out PE dx or not. These are the codes I have to code; 493.20,491.22,786.05 and I was going to code the rule PE. Please let me know. Thanks!


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## kbarron (Aug 19, 2009)

I didn't know that you could use rule out in IP. I was always told to use signs and symptoms.


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## Trendale (Aug 19, 2009)

*reply*

I read that as well, But I was also told that if that iss the only dx given and it is inpatient, you can code a rule out. I think on this one, there is other d's given as far as signs and syptoms, so i don't think I should code the PE. Thanks for your input.


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## mitchellde (Aug 20, 2009)

Rule out dx can NOT be coded by the physician coder regardless of place of service.  Only the inpatient FACILITY based coder may code the rule out as though it exists.  Even if the rule out is the only dx the physician gives you then you need to query for the signs and symptoms.


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## cheermom68 (Aug 20, 2009)

*Rule out*

Debra is completely correct.
LeeAnn


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