Home Health & Hospice Week

Hint:  Code a symptom to avoid coding a disease or condition that has been resolved.

Knowing when to report a symptom and when to leave it off your list of diagnoses will save you time and make your coding more accurate.

Before you start thumbing through your ICD-9 manual to find the codes for all of your patient's symptoms, take a moment to determine whether it's appropriate to include them, experts advise.

The Centers for Medicare & Medicaid Services says home health coders are allowed to list a symptom code as the primary diagnosis in the following three situations:

1. When the medical diagnosis is not yet established;
2. When using a symptom code will keep you from using an outdated diagnosis; or
3. When the symptom code most accurately portrays the patient's condition.

The bottom line: Before you code a symptom, first determine whether it's appropriate to do so for your patient. Know When You Need Symptom Codes Code a symptom when a definitive diagnosis hasn't been determined. "Normally I try to be more specific than using the symptom codes, but sometimes you don't have a specific diagnosis; you just have symptoms that are odd," says Lucie Carter Lopez, clinical supervisor with Interim Health Care in Fresno, CA.

Coding example: Physical therapy is providing gait training for a patient who is experiencing falls of unknown etiology. Code for this patient as follows, Sparkle Sparks, with Redmond, WA-based OASIS Answers suggested during the Eli audio conference, "Overcome V57.1-itis And Other Common Therapy Coding Challenges."

• M0230a V57.1 (Other physical therapy);
• M0240b 781.2 (Abnormality of gait); and
• M0245a 781.2 (Abnormality of gait).

In this case, the symptom (abnormal gait) is the focus of your care, and no specific diagnosis has been determined for this patient.

Code a symptom to avoid coding a disease or condition that has been resolved. When providing aftercare for joint replacement surgery, you can't code a disease process such as osteoarthritis or degenerative joint disease "because it should have been corrected at the point of surgery," says

In these situations, a symptom code can help justify the V code, which indicates the patient's care, she says.

Coding example: Nursing and physical therapy are providing care following a below-knee amputation due to gangrene. The patient is receiving gait training as well as aftercare. Report the following codes, suggests Lisa Selman-Holman, consultant and principal of Selman-Holman & Associates in Denton, TX.:

• M0230a V58.49 (Other specified aftercare following surgery);
• M0240b V49.75 (Lower limb amputation status; below knee);
• M0240c 781.2 (Abnormality of gait); and
• M0245a 781.2 (Abnormality of gait).

Code a symptom when it is the best description of your patient's condition.

Therapy is often only involved with a symptom, notes Sparks. In these cases, it's more appropriate to report [...]