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Pediatric Coding Alert

Reader Question:

Code Signs/Symptoms When Separate From Definitive Dx

Published on Thu Dec 06, 2012

Question: Can I report the diagnosis codes for tonsillitis, pharyngitis and upper respiratory infection together? Or do I just code the URI?

Texas Subscriber

Answer: In most cases, you can report multiple diagnosis codes for this visit. Although the ICD9-CM guidelines say that you shouldn't code symptoms and also the disease, it's possible that these symptoms are separate from the URI. So whereas you wouldn't code pneumonia and also code a cough or fever (as these are likely symptoms of the pneumonia), it is possible that tonsillitis or pharyngitis could be separate diagnoses in addition to the URI. The decision should lie with the pediatrician.

For instance, tonsillitis is inherent in pharyngitis, so you most likely won't report both at the same time.

If this was going on a claim to the insurance company, they certainly wouldn't deny it for all three codes. However, if you are trying to increase your medical decision-making (MDM) level by coding for three different problems, you would have trouble substantiating that, since the pediatrician likely didn't have to do any additional workup for each problem.

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