Wiki Diagnosis Expiration

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ashleysuits

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Good Morning All!

Today a fellow colleague has come to me asking for several thousands of dollars to be wrote off across our agency due to diagnosis. She is stating the the diagnosis expires after a year. Can you please confirm whether or not this is true? Do diagnosis expire after one year?
 
I am not sure what you mean exactly. A diagnosis never expires. As a condition it can be healed/cured and become a history of condition. As a code it remains forever. Now as a code it can change over time, such as from ICD-9 CM to ICD-10 CM hypertension changed from 401.9 to I10, but it is still a diagnosis of hypertension. Or from one year to the next it can change from a 3 character to a 4 character code. If you could elaborate on what your colleague is referring to that would help with a response.
 
We work at a mental health and substance abuse outpatient facility. She is stating that the doctor needs to go in each year and review the diagnosis. They are in the ICD-10 format, but she is stating that because the diagnosis was not re-added to the EHR system manually we will have to write them off. They review them each time they attach them to their notes, but they do not actually retype them in. Mental health diagnosis don't change as often.
 
The provider must document the patients condition at each encounter not just review the past record. I am still missing something here. I understand mental health diagnosis do not change much, however the provider must still document the diagnosis and it’s current status.
 
Maybe it's because the documentation is insufficient? A doctor needs to do more than simply copy and paste the note from visit to visit. If the physician has been doing that for over a year I can see why they have a problem with it.
 
Thank you both. Their documentation supports the diagnosis listed. They are updating notes, but as far as the ICD-10 code they carry it over to their new notes and elaborate if there has been any new or worsening symptoms. I believe it was an error on my colleagues part as she is stating they expire each year.
 
I should probably mention she is not a coder. She works in our compliance department, and does not understand coding.
 
The Medicaid plan in the state where I work does have certain documentation requirements for behavioral health facilities that require the providers do a periodic review of the patients' care plans. You colleague may be referring to a payer or regulatory requirement such as this, so it may be a case of missing paperwork rather than an expired diagnosis. Best if you discuss it with her and get clarification as to what she means - it sounds like something is being lost in translation here.
 
Thank you. I asked if it was a paper work update. She said no that she was referring to the diagnosis. We update our paperwork annually. All paperwork had been updated accordingly.
 
So she is saying then that the code number expires after one year? again this is not true. And even if it was it would have no bearing on writing off charges. See coding clinic 1st quarter 2012, in this it states the code number should not be in the medical record document, and the provider is not to use the code number in lieu of a narrative rendered diagnosis. so even if the provider carries the code over, as long as they are documenting the diagnosis in their own words, then that is sufficient. The code number may in fact change, but that does not render the diagnosis as expired. there is nothing wrong with the code number selected by the coder being different from the one selected by the provier as long as the coder matches the rendered diagnosis.
 
Yes, she is stating that the code it's self is expired and would need to be updated. When all documentation supports that code.
 
Then again she is incorrect on this. Some codes stay the same year after year and some are updated to include additional characters and in a few isolated case a number changes completely and even more rare a number is deleted. However none of that matters from a documentation perspective. A diagnosis itself never expires because the diagnosis belongs to the patient. As I stated earlier the actual code does not even belong in the medical record document.
 
I agree. The Dx doesn't expire. It may change year to year but per evaluation, claims should be valid with supporting documentation. A year's worth of claims is substantial. You might come up with timely filing issues but that is not due to Dx.

Peace
@_*
 
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