Wiki specific dx code

[jbhuju]

hello,
i do have a question, if patient has fever, cough one of our providers coded this dx and our coding software is not allowing us to bill the dx stating need s to have specific dx. i do not se ethat the dx can not be billed on guidelines. please help.
thank you

 

[andersona1229]

I didn't see anything in guidelines either, but if they had other symptoms I would ask the provider about it. It might be an edit in the coding software that you're using. If the patient had a fever and cough, those are probably the better codes to use hence why I would speak to the provider.

 

[sls314]

Under the assumption that a definitive diagnosis was not established by the end of the encounter:


For fever, you would assign a code from the R50 category. R50.9 is fever, unspecified, and there are additional R50.- fever codes that are more specific.

For cough, you would assign a code from the R05 category. R05.9 is cough, unspecified, and there are additional R05.- cough codes that are more specific.

It should be quite rare that R68.89 would need used. I can understand why your billing system would be set up to flag for review on whether that code is truly appropriate.

Examples of some Alphabetic Index terms that lead to R68.89 include:

Dysfunction, physiological NEC
Abnormal, clinical findings NEC
Infirmity
Symptoms NEC

That's not a complete list, but you get the idea.

Most of the time, if there is medical necessity for a visit, you would likely have a more specific sign or symptom code to use.