Podiatry Coding & Billing Alert

Question: Whose responsibility is it to place multiple diagnoses in order of severity — the provider or the coder? Are there any guidelines for this?

AAPC Forum Participant

Answer: In actuality, there is no guideline stating multiple diagnosis codes should be placed in order of severity. So, whose responsibility it is to do this is a moot point.

However, you should be responsive to two ICD-10-CM guidelines about which codes to list, and which should be first-listed, when you report multiple diagnosis codes:

Guideline IV.G tells you that your first-listed code should be the condition that has caused the encounter, which may not necessarily be the most severe condition. The guideline tells you to “List first the ICD-10-CM code for the diagnosis, condition, problem, or other reason for encounter/visit shown in the medical record to be chiefly responsible for the services provided.”

Guideline IV.J tells you that you should add codes for “all documented conditions that coexist at the time of the encounter/visit and that require or affect patient care, treatment or management.”

Remember: On outpatient claims, sequencing of multiple diagnosis codes rarely, if ever, affects payment. As long as all of your codes are properly supported by the documentation, code sequence is not as significant an issue as it seems.