E/M Coding Alert - 2013 Issue 26
Reader Question: Use 'Feigned Illness' Dx Code When Necessary
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Article Overview
This article addresses a practical coding question about a short new-patient office encounter where the clinician suspects feigned symptoms and the patient leaves before completing requested office policies. It is aimed at coders and billing staff who need to understand how provider documentation, visit context, and diagnosis selection may affect claim reporting. The discussion stays focused on general documentation-based coding considerations and the broad issue of whether a non-symptom diagnosis may be appropriate.
Why This Topic Matters
Choosing the diagnosis code that best matches the documented encounter affects claim accuracy and helps align billing with the clinician’s assessment. The article is relevant to practices handling potentially deceptive presentations, incomplete workups, and brief E/M visits.
What You Will Learn
- How documentation affects diagnosis selection for an office encounter
- How a brief visit with a declined test may be approached from a coding perspective
- Why staff may want to coordinate with the treating practitioner when a presentation seems inconsistent
- How practices may track repeated suspicious encounters for future reference
Who Should Read This
- Medical coders
- Billing staff
- Practice managers
- Clinicians documenting office visits
Codes Discussed
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