Wiki Written Dx vs Dx Code Given Question

[gbgentry@earthlink.net]

We're having a little debate at our office right now. Some of the coders are saying that the
written Dx description should/has to be used and supersedes any code given.
Others are saying that it's ok to use the code.
Any example is Hyperlipidemia E78.2

The issue came up recently when an OP disqualifier was in the written description,
which would normally make it invalid. Possible Hyperlipidemia E78.2
New order needed? Or just use the E-code?

 

[thomas7331]

You must use the provider's statement and not the code. Per ICD-10 guidelines: "The assignment of a diagnosis code is based on the provider’s diagnostic statement that the condition exists." If the provider has stated 'possible', that is not a definitive statement that the patient has this condition and for outpatient coding, that cannot be used.

You should never use a code as a diagnosis because a code is not a diagnosis, it is a classification. As in the example you've given, if you look up E78.2 in the ICD-10 you'll see that this is not a single diagnosis, but rather a classification code for a number of different types of 'mixed hyperlipidemia'. (In fact, if the statement is only 'hyperlipidemia, that would be coded as E78.5, and E78.2 would be incorrect because there is no documentation to support it.) So a code can never tell you what the patient's diagnosis really is. The provider should always state their impression, and the code is derived from that statement, never the other way around.

 

[gbgentry@earthlink.net]

Don't necessarily disagree but when the Lead Coder basically say "Everyone should just accept it so that we can get them closed faster",
it gives you pause.

 

[thomas7331]

Yes, true, but the unfortunate reality is that every organization has to consider the audit risks against the costs and benefits of following particular policies and procedures. Hopefully, your lead coder has reviewed enough cases to know that the codes have a high enough accuracy rate that it does not warrant holding up claims and having coders validate or re-review them - at least, that would be my approach if I were in their shoes.