Wiki Dx coding ?

[Kimberley]

If you have a symptom AND a definitive finding in a report....you only code the finding correct ?


Example...if a patient has gallstones and has abdominal pain...you code gallstones...say Medicare denies it, you can't code abdominal pain just to get the claim paid if abdominal pain is payable on the LCD, correct ?

Thanks

Kimberley

 

[sbicknell]

General rule is you code the abnormal finding as the primary DX (gallstones). If there is no abnormal finding, then you code the indication for test (abd pain)

Can not flip-flop on the DX hunting for one that reimburses. The DX is always based on the physician's documentation

Exception is if test was done as a screening. Then sequence is: Screening V code followed by abnormal finding

Just curious, what test was done and with what DX codes? The abd pain/ gallstones are so interelated that I wonder why they are denying the test for a more specific DX of GS rather than a general DX of AP.