You Be the Coder:
Two Services in One Day
Published on Tue Jan 01, 2002
Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer.
Question: A patient came into the office for an upper respiratory infection. She was placed on antibiotic therapy. Two days later, she returned complaining of severe epigastric discomfort related to the medication. The physician changed the medication, and it was well tolerated. How can the physician justify and be paid for two services in one week?
Utah Subscriber
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Answer: The physician must provide medical necessity for each service. When the patient presents to the physician or nonphysician practitioner with symptoms of an upper respiratory infection during the first service, the provider should choose diagnosis codes to match the patient's condition.
For example, the patient may have a cough (786.2), sore throat (462) and fever of nonspecific origin (780.6). The provider may determine that this cluster of symptoms is consistent with an upper respiratory infection (465.9). When submitting diagnosis codes for any visit, the provider may list up to four. In this case, the physician should submit all of the above codes to paint an accurate clinical picture.
When the patient returns to the office complaining of epigastric pain, that visit represents an adverse reaction to the prescribed medication. This is a good example of when to use E codes, which describe circumstances that caused the injury, not the nature of the injury.
Because the patient has been following the provider's treatment and has been taking the antibiotics as recommended, the correct coding is:
Epigastic pain (789.06) is diagnosis number 1;
If the provider has determined the symptom(s) to be related to the therapeutic use of the antibiotic, the provider should use the appropriate E code to identify the drug (for example, if the patient has been taking erythromycin, report E930.3).
If the patient still has symptoms of an upper respiratory infection or URI (465.9), the provider should also code this diagnosis. | |
