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The ICD-10 book will be your best friend. I know most people had codes memorized but people will just have to go back to the basics and look up codes in the index and verify, until that memorization kicks in

Here is the steps I followed

Looking at sore throat the I10 index referred my to pharyngitis which led to J02.X which includes acute sore throat. The only options were Strep (.0), other bacterial (.8) or unspecified (.9). I went with unspecified J02.9 which lists sore throat (acute) NOS
 
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J02.9 acute pharyngitis unspecified

We have been told not to use unspecified codes but I don't see any other option for just plain on sore throat.

Also running into the same issue with URI.

Please advise!


Mindy Davis CPC
VMG
 
an unspecified code may be the most appropriate code, particularly in this case where you're not sure if it's strep, or something else.

The unspecified codes that will be worrisome are the ones that indicate laterality.
 
The coding guidelines now have a guideline for unspecified. If the information to be more specific is not known or available in order for the provider to be more specific then unspecified is the correct choice.
Infections and infectious conditions the provider may diagnose base solely on the patient presentation. Therefore without a culture or other diagnostic study there is no way for the provider to have more specific information.
I tell my classes that when you get ready to put an unspecified code down, just ask yourself if it is logical and reasonable that the provider could not have access to the more specific information. If you can create a reasonable appeal in your head then go ahead and use it. A response of "we just did not get the report" is not a good response!
 
Our group is an ED and in our state if we used unspecified codes as the primary or secondary code Blue Cross, Cigna and Tenncare's will reduce our payments to a flat rate fee of $50.00. I realize sometimes unspecified codes will be our only option because labs and culture reports will not be back before the pt is discharged. ICD-10 is still so new to all of us. I was just trying to see if any other groups had heard anything different in regards to unspecified codes in the ED.

Thanks!

Mindy Davis CPC
 
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