tci Outpatient Facility Coding Alert - 2016 Issue 12

You Be the Coder: Distinguish When to Code a Diagnosis vs. a Symptom

Question: The provider documented the following results: “positive for UTI associated organisms and antibiotic resistance detected.” What ICD-10 codes would you assign to this? Minnesota Subscriber Answer: You will need to know whether there is a confirmed diagnosis here. As per guidelines, we can only code a confirmed diagnosis. In case if it is not given, you may go ahead and codethe symptoms instead.  Remember that you may only code a symptom with a confirmed diagnosis when the symptom is not associated with the confirmed diagnosis. As per current documentation you have provided, you may report...

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