Wiki multiple chronic illnesses

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cbeste

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I am new to coding and would greatly appreciate some help. At the family practice clinic where I work, many of the adult patients have multiple chronic illnesses. Often when they come in for a follow up office visit, the physician addresses eight to ten ICD-9 diagnoses. The billing department, however, can only link up to 4 diagnoses to each CPT code. So when the patient is seen for a 99214 visit, for example, and that is the only CPT code billed, is it necessary to report all of the ICD-9 codes that the doctor evaluated? Or should the doctor just choose the four most important diagnoses that he/she evaluated?
Thanks very much.
 
You should use the CC or reason for the visit and work from there. Yes, there are multiple chronic conditions, but did your doctor address each one? Your doctor should prioritize the diagnosis codes as # 1, # 2, #3, and not just check mark 8 codes.
 
Thanks very much for the reply, Marcus. I will give you an example to clafiry my dilemma. A patient was scheduled for f/u visit for multiple chronic conditions. The provider assessed the patient for symptoms related to coronary artery disease, RICA stenosis, peripheral vascular disease, and chronic systolic heart failure, reviewed medications, and gave a referral to cardiology. The patient also has a history of CABG which should be coded with the CAD. The patient also presented with a cough related to long-term history of smoking, as well as worsening back pain. Both of these issues were assessed and required medication management. The only CPT code billed is 99214. Should all of the ICD-9 codes for this visit be submitted to insurance, even though only 4 can be linked to 99214?
 
Since we are limited to four diagnosis codes, I would use the four that give the best overall picture of the patient's condition on the date of service in question.
 
Thanks very much. I am still a bit unclear on something. On the electronic claim forms, up to 12 ICD-9 diagnoses can be listed. However, only 4 ICD-9 codes can be linked to each CPT code. In the above example, should all of the ICD-9 codes be submitted regardless of the fact that only the top 4 can be linked to 99214?
 
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