Wiki Counting chronics for HPI with combination codes

[mcarrillo]

Hello,
I had posted this last month and no one replied, so I'm posting this again hoping someone will give any feedback about it.

When counting for 3 chronics for HPI instead of the elements, could 2 count from a Dx that has two problems? Example E11.21 type 2 DM with nephropathy (1 for DM and 1 for nephropathy). In the ICD-10 guidelines it states that a combination code is a single code used to classify: Two diagnoses, or a diagnosis with an associated secondary process (manifestation) & a diagnosis with an associated complication. If anyone knows of other guidelines or policy regarding this I would really appreciate it.

Thank you

 

[thomas7331]

I don't know where this has been addressed in any official guidelines, but I'll give you my take on it. I think that the way conditions are coded ICD and how they're counted for purposes of E&M coding are really two different things, and it's like comparing apples and oranges. When you're coding an E&M document, you have to evaluate the elements based on how the provider documented their work, not based on how you'll code the diagnosis. A chronic condition, in the context of coding an E&M, is an identifiable problem that the patient is presenting with (for HPI) or that the provider is managing (for MDM), regardless of the number of codes that will be used.

The guideline for the HPI is that the provider should document the status of the chronic conditions. So in your example, if the note states that the patient has diabetic nephropathy which is stable on current medications, I'd count that as only one condition even though there are two codes associated. But if it also states that the patient's diabetes is well-controlled on SSI, then that's a second problem since it's been identified as such in the note by giving the status.

I use that same approach in the MDM section too, since the provider's assessment and plan should also reflect each problem that is being managed, not the number of codes that it takes to represent those problems. Hope that helps some - not sure if everyone will agree, but that's my interpretation of what the E&M guidelines intend.