CODING CORNER: Outpatient Diagnosis Coding Got You In a Bind?

Unravel your difficulties with expert insights
CPT codes map to APC payments, but incorrect outpatient codes map to APC pay-diagnosis coding can cost your facility a bundle, especially when you're administering expensive tests or drugs. Don't let mediocre documentation efforts sell your budget short.
Multiple Complaints? Use Multiple Codes
When a patient presents in the outpatient department -- particularly in the emergency room (ER) -- you should report all the coexisting conditions that affect the treatment for the encounter, advises Tammye Francis, RHIT, CCS, regional health information management director for Community Health Systems, who presented on outpatient diagnosis coding at the 12th Annual American Academy of Professional Coders Conference in Atlanta. For example, if the patient comes in with a fever (780.6), chest pain (786.50) and cough (786.2), and has chronic obstructive pulmonary disease (496), you should report all four, she says.
"That way, if there are additional [diagnostic] tests," such as blood tests and x-rays, "we've documented all of the current issues that the patient has, plus that underlying condition that may impact how the physician treats the patient," Francis says.
For instance, suppose a patient comes in for a follow-up arthritis visit, and she has skyrocketing blood pressure. The physician spends the majority of the visit attending to the high blood pressure (401.x). The patient needs an x-ray or contrast scan to monitor the arthritis (716.9x), but the doctor cannot perform the test because the patient's blood pressure is too far elevated.
In this scenario, your diagnostic justification for the x-ray or scan would be arthritis, so you should report that first. But you should also add "elevated blood pressure" because that tells insurers that although you intended to perform the tests to determine the status of the patient's arthritis, you couldn't because of her hypertension.
Coding significant chronic/comor-bid conditions on outpatients enhances compliance on any testing associated with the patient's evaluation or treatment, says Ruthie Burden, CCS, CPC, CPAR, health information management coding specialist at St. Joseph Hospital in Augusta, Ga. Burden recommends coding diagnoses such as hypertension, chronic obstructive pulmonary disease, diabetes, any heart-related diseases, or any condition that may increase the risk of treating the patient's condition.
Play by the FI's Rules
Make sure you know what information your fiscal intermediary (FI) needs to pay for certain tests, and that you document the proper diagnosis when you run those tests, Francis says. For example, a patient presents with chest pain in the ER. The ER physician orders an x-ray and troponin assay. Suppose your FI is Mutual of Omaha, which only pays for tro-ponin with a diagnosis of chest pain (786.50). After [...]

- Published on 2004-06-10