Wiki primary care coding for accident versus symptoms

[amexnikki23]

Hi, the providers I'm auditing encounters for mostly use symptomatic coding for injuries/accidents ie. patient fell on ice at home comes in 3 days later, instead of coding the injury, contusion, etc. he codes, swelling and pain. Is this okay from a PCP coding perspective?

 

[mitchellde]

It really depends on what the documentation states. If no contusion is visible then it will not be documented and can not be coded. All coding depends on the documentation. If the contusion is documented with pain and swelling of the same site then I would probably code only the contusion but again it will d pend on what is stated in the note.

 

[rvalente]

It is ok that he/she reports his/her codes that way...

The clinician "should" report an accurate diagnosis so we can assign codes to the highest specificity.

Injury, abrasion, contusion etc., would be more accurate and specific than coding pain and swelling.

The importance of reporting the condition accurately, including the patient's fall, is in statistical data for the healthplan/medical group.

 

[mitchellde]

It is ok that he/she reports his/her codes that way...

The clinician "should" report an accurate diagnosis so we can assign codes to the highest specificity.

Injury, abrasion, contusion etc., would be more accurate and specific than coding pain and swelling.

The importance of reporting the condition accurately, including the patient's fall, is in statistical data for the healthplan/medical group.

I disagree with the last statement. The diagnosis is the patient's and the importance of correctly and accurately reporting the patient diagnosis can have a direct impact on the patient. Payers make decisions regarding a patient'insurance and benefits based on the diagnosis codes reported. We as coders have a responsibility to be 100% accurate with every diagnosis code we report.