Wiki EGD diagnosis

[kboyd22]

Pre-indicator states Reflux, sometimes GERD(this is an on going issue), however the procedure report/findings state normal esophagus, normal stomach, normal duodenum. Would you still use the reflux/GERD ICD-10 code?

Thank you

 

[mitchellde]

I have run into this a lot. When I look at the notes the provider is using the term reflux as a symptom and not as a diagnosis. as in "the patient has episodes of reflux". Unfortunately there is no code that can describe this in the same way. when the pathology states normal and it is not a follow up for having previously been diagnosed with reflux then no I do not code it as the pathology is clear that this is not a diagnosis for this patient. I will look to see what else is documented for this patient and usually there is some other symptom, if not then I use Z03.89 for condition not found and that has never failed.

 

[kboyd22]

Glad to know we are not the only ones with this issue. Our problem with the Z03.89 is it is not a covered diagnosis for LCD, so it denies for medical necessity and our procedure reports do not have any other signs or symptoms

 

[mitchellde]

I know it is not on the LCD however we have never had it deny. If it does you should appeal with the path report and the clinic note. What you cannot do is submit a diagnosis that the patient clearly does not have.

 

[kboyd22]

Thanks for your help! We are going to try that and follow it to see what happens!