Medicare Compliance & Reimbursement - 2020 Issue 6
Reader Question: Laser Focus Reason for Visit
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Article Overview
This article addresses a common coding scenario in which a patient is evaluated for a suspected surgical condition that is not found on examination. It explains the general diagnosis-coding considerations involved in choosing an appropriate reason-for-visit code versus a confirmed condition code, and it references ICD-10-CM guidance and routine exam coding concepts. The piece is aimed at coders and billing staff who work with physician office evaluation and management documentation.
Why This Topic Matters
Getting the diagnosis code right for an unconfirmed condition affects medical necessity reporting, claim accuracy, and compliance with ICD-10-CM coding guidance. The article helps coders distinguish routine-exam reporting from symptom- or concern-based reporting in a surgical office setting.
Article Sections
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Question
Presents the coding scenario and asks how to report the diagnosis for a surgeon’s evaluation of a suspected condition that is not confirmed.
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Answer
Provides guidance on diagnosis-code selection for the encounter and references ICD-10-CM principles related to uncertain or unconfirmed diagnoses.
What You Will Learn
- How to think about diagnosis coding when a suspected condition is evaluated and not found
- When routine exam coding concepts may or may not apply to an office evaluation
- How ICD-10-CM guidance affects reporting of unconfirmed diagnoses
- How to identify the broad type of diagnosis code that may fit a feared-condition scenario
Who Should Read This
- Medical coders
- Billing staff
- Physician office staff
- Revenue cycle professionals
Codes Discussed
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