Otolaryngology Coding Alert

Question: Are we required to continue including old diagnoses on a patient claim when we’re billing for a new diagnosis? I thought CMS guidelines required us to show old diagnoses for continuity of care, but others in my office disagree. Can you please advise?

West Virginia Subscriber

Answer: The documentation supporting a claim should include the final diagnosis, condition which is still present in the patient, or the “history of” diagnosis code that can indicate the patient had the specific disease previously.

If the diagnosis was not confirmed, the documentation should include terms such as rule-out, versus, probable, possible, differential, suspected, working, etc., relating to the diagnosis (undeveloped as yet diagnosis: awaiting further study). In these instances, code the most specific signs/symptoms, exposure to, or personal or family history diagnosis that applies.