Primary Care Coding Alert

Question: A colleague said to try not to use unspecified ICD-10 codes. However, numerous patients lately are coming in for a sore throat and a fever, and I don’t see how I can code anything but unspecified codes if my provider hasn’t documented more specific information. What do I do?

AAPC Forum Participant

Answer: You don’t want to report unspecified codes when there are other, more accurate and more specific codes for the encounter, but sometimes unspecified codes are the most appropriate.

For example, if the situation you’ve outlined is a first encounter and the provider ordered a throat culture or other tests, the test results won’t likely be ready for a few days. The provider can’t yet definitively identify the reason for the sore throat or fever, yet the encounter still needs to be reported to the highest specificity. This situation would therefore call for codes such as J02.9 (Acute pharyngitis, unspecified) and R50.9 (Fever, unspecified).

If your provider hasn’t documented specifics, but there appear to be test results, medication prescribed, or other clues that there is vital information missing that prevents you from coding to the highest specificity, talk to the provider and get more details. Assigning unspecified codes is not correct if additional information is available to identify a more specific diagnosis.