Wiki Diagnosis Coding regarding Inpatient Admissions

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TThivierge

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Hello

This question is geared for coders process inpatient admissions diagnosis codes. If the hospitalist or attending physician list 4 or 5 diagnosis codes for the patient for the day of treatment while doing a subusqent hospital visit should not the coder list all diagnosis given? I know unspecified dx. codes can be used in the inpatient setting per the regulations. Is not the medical coder to list all of them on the claim in the proper sequence? I know DRG and POA are related together for the reason the patient arrives and got treatment thru the ER or for their inpatient status. Also I know patients treated by the physician medical specialist may use their dx code related to the care of the patient in regards to their professional medical specialty such as: Ortho, Cardiac,OB/GYN, or Psychiatry.

Thank you in advance

Lady T
 
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Diagnosis Inpatient Answer

TThivierge said:
Hello





This question is geared for coders process inpatient admissions diagnosis codes. If the hospitalist or attending physician list 4 or 5 diagnosis codes for the patient for the day of treatment while doing a subusuqent hospital visit should not the coder list all diagnosis given? I know unspecified dx. codes can be used in the inpatient setting per the regulations. Is not the medical coder to list all of them on the claim in the proper sequence? I know DRG and POA are related together for the reason the patient arrives and got treatment thru the ER or for their inpatient status. Also I know patients treated by the physician medical specialist may use their dx code related to the care of the patient in regards to their professional medical specialty such as: Ortho, Cardiac,OB/GYN, or Psychiatry.

Thank you in advance

Lady T
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Answer
I researched the answer and per CMS all dx. given by treating physician should be listed on claim. This is vital due to statistics for hospital and can affect payments.
 
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