I am having trouble with code a diagnosis for an appendectomy. The patient arrives in the ER and has severe right lower quadrant pain. The doctor takes her to the operating room for appendectomy for possible appendicitis. The path report states that the specimen is ?suggestive of acute appendicitis?. For the dx would I code the right lower quadrant pain since the report says suggestive or would I code the acute appendicitis. Thanks
-
If this is your first visit, be sure to check out the FAQ & read the forum rules. To view all forums, post or create a new thread, you must be an AAPC Member. If you are a member and have already registered for member area and forum access, you can log in by clicking here. If you've forgotten your username or password use our password reminder tool. To start viewing messages, select the forum that you want to visit from the selection below..
Wiki "Suggestive of acute Appendicitis"
- Thread starter lindafay1123
- Start date
mitchellde
True Blue
Code the pain you cannot code a suggestive dx.
aloha_coder14
Guest
- Messages
- 8
- Best answers
- 0
in-patient admission
I am a student preparing for certification exam. I understood outpatient cannot but in-patient admissions CAN be coded for "possible, rule out, suggestive, maybe" and coded as existing diagnosis. The basis is the workup. studies and continued investigation. Please clarify or correct me. Thank you.
I am a student preparing for certification exam. I understood outpatient cannot but in-patient admissions CAN be coded for "possible, rule out, suggestive, maybe" and coded as existing diagnosis. The basis is the workup. studies and continued investigation. Please clarify or correct me. Thank you.
mitchellde
True Blue
The inpatient facilty coder can code possible,probable, suspected as though it exists. All other coders cannot.
danachock
Expert
coding "suggestive"
You cannot code "suggestive" unless you are inpatient. You may code the pain only from this pathology report.
Maybe this explanation will shed a little light. I am going to try and explain this the best I can. For most insurance carriers (except Medicaid "off the top of my head") the POS (place of service) on a pathology is #22 - please refer to your CPT book,#22 is a portion of a hospital that provides diagnostic, therapeutic (both surgical and nonsurgical), and rehabilitation services to sick or injured persons who do not require hospitalization or institutionalization.
POS #22 is different then inpatient which is POS #21
Thanks,
Dana Chock, CPC-A, CCA, CANPC, CHONC
2013-2014 Brainerd AAPC Chapter President
You cannot code "suggestive" unless you are inpatient. You may code the pain only from this pathology report.
Maybe this explanation will shed a little light. I am going to try and explain this the best I can. For most insurance carriers (except Medicaid "off the top of my head") the POS (place of service) on a pathology is #22 - please refer to your CPT book,#22 is a portion of a hospital that provides diagnostic, therapeutic (both surgical and nonsurgical), and rehabilitation services to sick or injured persons who do not require hospitalization or institutionalization.
POS #22 is different then inpatient which is POS #21
Thanks,
Dana Chock, CPC-A, CCA, CANPC, CHONC
2013-2014 Brainerd AAPC Chapter President
mitchellde
True Blue
Just to be clear it is only the facility coder coding for inpatient that is allowed to code an uncertain diagnosis as though it exists. If you are coding for the physician it does not matter the POS 11, 22, or 21 the coder may not code uncertain diagnosis.
aloha_coder14
Guest
- Messages
- 8
- Best answers
- 0
Thanks Debra. This clears it up for me.