Internal Medicine Coding Alert
ICD-9: You Should Claim Primary Reason as D1
Question: Should I first report the original diagnosis or the manifestation?
North Carolina Subscriber
Answer: You should report the complication first followed by the background. Prioritize the diagnoses in order of descending order of importance, starting with the one that receives the most attention at the visit.
For instance, a patient with an upper respiratory infection (URI) develops chest pain from coughing. So, the family physician sends the patient to a radiologist for a chest x-ray. The radiologist interprets the results as normal. In this case, you should report the symptom, chest pain (786.50, Chest pain, unspecified), which prompted the chest x-ray, in the first position (diagnosis 1, D1) on the claim form.
List the initial cause, the URI (465.9, Acute upper respiratory infections of multiple or unspecified sites; unspecified site), in the second position. Reversing the order and reporting URI in the first position may trigger a denial. Code 465.9 doesn't prove the medical necessity for a chest x-ray, but 786.50 clearly tells the payer why the FP ordered the test.
Internal Medicine Coding Alert
- Nebulizer Services:
Don't Let the Differences Between Treatment and Training Trip You Up
Tackle common coding problems with our case studies Does your internist treat respiratory conditions, such [...] - You Be the Coder:
Which Conditions Get Priority?
Question: Our physicians are treating a patient's respiratory insufficiency. They think that the patient's COPD [...] - Are You Ready for an Internal Chart Review? 4 Quick Tips
Why modifier -25 could be costing you deserved payment If your office has been receiving [...] - You Can Report CPO Services With Confidence - Here's How
Medicare and private payers require different codes If your internist isn't documenting his care plan [...] - Reader Questions:
Time, Documentation Critical to 99291 Payment
Question: In the afternoon, our internist saw a patient for 30 minutes on the hospital [...] - Reader Questions:
Modifier -25 Use Means Global Period
Question: Am I supposed to use modifier -25 when I bill an E/M service in [...] - Reader Questions:
Look for Diabetes Screening Coverage Next Year
Question: I've heard that Medicare will start covering diabetes screening tests soon, but exactly what [...] - Reader Questions; X-Ray Interpretation Only? Add -26
Question: How should we report a scenario in which the physician did not take x-rays [...] - Reader Questions:
Breathe Easy When Coding Asthma Visits
Question: One of our asthma patients presented with a little chest tightness and required a [...] - Reader Questions:
Charge for Bottles of Tylenol
Question: Is there a HCPCS code for the supply of Tylenol for a sick patient? [...] - Reader Questions:
Here's Why You May Not Need Modifier -51
Question: I noticed that CPT includes modifier -51 for "multiple procedures." I never append this [...] - Reader Question:
ICD-9: You Should Claim Primary Reason as D1
Question: Should I first report the original diagnosis or the manifestation?
North Carolina Subscriber
Answer: You should [...] - Here's Why the 5th Digit Isn't Always the Key to Accurate ICD-9 Coding
Get the expert tips you need to prevent denials If you are submitting CPT codes [...] - You Be the Expert:
Has ICD-9 Coding Lost Its Grace?
Question: Has CMS ended the 90-day grace period for getting used to new ICD-9 codes? [...]
