|Home » Categories » ICD-9-CM Coding|
Coding Signs and Symptoms vs. Imaging Results
|Article Number: 54 | Rating: Unrated | Last Updated: Tue, Nov 16, 2010 10:13 PM|
The out patient’s order lists signs and symptoms for the chest x-ray. The report comes back negative. Do we code from the report or can we use signs and symptoms?
Coding rules allow you to do either. The official guideline is:
For patients receiving diagnostic services only during an encounter/visit, sequence first the diagnosis, condition, problem, or other reason for encounter/visit shown in the medical record to be chiefly responsible for the outpatient services provided during the encounter/visit. Codes for other diagnoses (e.g., chronic conditions) may be sequenced as additional diagnoses. For encounters for routine laboratory/radiology testing in the absence of any signs, symptoms, or associated diagnosis, assign V72.5 and a code from subcategory V72.6. If routine testing is performed during the same encounter as a test to evaluate a sign, symptom, or diagnosis, it is appropriate to assign both the V code and the code describing the reason for the non-routine test. For outpatient encounters for diagnostic tests that have been interpreted by a physician, and the final report is available at the time of coding, code any confirmed or definitive diagnosis(es) documented in the interpretation. Do not code related signs and symptoms as additional diagnoses.
There are no attachments for this article.
Adenoma vs Adenocarcinoma
Viewed 1761 times since Thu, Jun 23, 2011
Viewed 1672 times since Wed, Nov 17, 2010
Viewed 4566 times since Mon, Apr 25, 2011
Tricompartmental Degenerative Disease
Viewed 4115 times since Thu, Jul 21, 2011
Acute Versus Chronic Conditions
Viewed 1579 times since Thu, May 12, 2011
Surgery For FB Foot Nothing Found
Viewed 1323 times since Thu, Apr 28, 2011
Rhomboid Sprain Diagnosis
Viewed 3283 times since Fri, Dec 16, 2011
3-Day Payment Window/POA
Viewed 2313 times since Fri, Dec 3, 2010
Viewed 1320 times since Fri, May 6, 2011
Coding Guidelines For Symptoms
Viewed 2527 times since Thu, May 12, 2011