Medicare Compliance & Reimbursement
Know the Facts on Coding Common Colds
Question: With cold and flu season already ramping up, we are seeing a disordinate amount of patients presenting with cold symptoms. We are confused about what to report. If a patient has a sore throat and a cold, do we code both conditions? Massachusetts Subscriber Answer: No. In situations like this, you report only one of the conditions. Expert coding tip: A common cold is reported with J00 (Acute nasopharyngitis [common cold]). You’ll notice several Excludes1 instructions for the various conditions typically accompanying a cold: A sore throat not otherwise specified is reported with J02.9, which is mutually exclusive (Excludes1). Thus, you can report only one of the two conditions. Since the sore throat typically accompanies the cold, reporting the cold (J00) captures both conditions. Note: There may be some respiratory illness encounters that call for the use of a second code. If the notes indicate the patient is a smoker or is exposed to tobacco smoke, follow the Use additional code instruction telling you to report codes such as Z77.22 (Contact with and (suspected) exposure to environmental tobacco smoke (acute) (chronic)), F17.- (Nicotine dependence), or Z72.0 (Tobacco use).
Medicare Compliance & Reimbursement
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