ED Coding and Reimbursement Alert
No Diagnosis Listed? Here's What to Report
Question: I have an ER chart where my doctor listed as the final diagnosis well baby exam V20.2. I know payers don’t like that code and won’t pay. In the ED chart, it says benign exam, in HPI, it says that according to the parents, the patient had decreased urine output, patient crying with urine, no fever. He did labs and also gave IV fluids; the coder coded 788.5 as the final diagnosis, I sent it back to her and told her we could not change the doctor’s diagnosis. What should I have done?
Nebraska Subscriber
Answer: The standard answer to your question is in the absence of a final diagnosis, report the signs and symptoms that were noted in the chart. That’s why your coder considered 788.5 (Oliguria and anuria) for the decreased urine output. However, you are correct, that you should not change the physician’s assigned diagnosis for payment purposes. Absent any documented diagnosis or symptoms, consider using a V code such as V20.1 (Other healthy infant or child receiving care). Depending on the age of the patient, you might also consider 780.91 (Fussy infant [baby]) or 780.92 (Excessive crying of infant [baby])
You could also consider ICD-9 code V71.89 (Observation for other specified suspected conditions) for the suspected but not confirmed symptom of decreased urinary output.
ED Coding and Reimbursement Alert
- 2014 Medicare Physician Fee Schedule:
Expect a Two Percent Payment Boost For ED Services
RVUs drop slightly, but overall payments will increase because of the MEI reweighting. The results [...] - OPPS Final Rule Update:
Good News: Your ED Facility Levels Get a Reprieve
Payment levels also increase in 2014 OPPS final rule. For now, you can expect the [...] - Clip and Save:
Keep These Charts Handy to Track 2014 RVUs for Common ED Services - Clip and Save:
Chart Guides Your 2014 ED Facility Reporting
The table below summarizes the facility reporting of ED and outpatient clinic visits for 2014: [...] - PQRS Reporting:
Quality Reporting Takes the Next Step on Data Collection and the Value-Based Modifier
Don’t miss these changes to the CMS Physician Compare website data. The final rule also [...] - ICD-10 Coding:
Look Sharp and Listen Up: ICD-10 Brings These Changes to Your Eyes and Ears Disease Diagnoses
Exact anatomical location and laterality are the buzzwords for dealing with eye and ear presentations. [...] - You Be the Coder:
Nail Dx for Complicated Facial Injury Presentation
Question: What ICD-10 codes would you assign to the following case? Hx. of present illness. [...] - Reader Question:
No Diagnosis Listed? Here's What to Report
Question: I have an ER chart where my doctor listed as the final diagnosis well [...]
