ICD ICD-9-CM guideline on uncertainty Dx

[Chaim]

In guideline section 3.c. - uncertain Dx, it states if diagnosis is documented as "probable" etc., code the CONDITION as if it existed or was was established.

In guideline section 4.I. - uncertain Dx, it states do not code diagnosis documented as "probable" etc., rather code the condition to the highest degree of specificity.

I under stand section 3 refers to inpatients and section 4 for outpatient, but what I do not understand is it uses the word condition as if it is the same thing as Dx in section 3, and the word condition as if it were different than Dx in section 4.

Can someone please clarify this for me?

Thanks,

Chaim

 

[Laureen]

I'll try to explain with an example:

A patient comes in with sore throat (condition) and doctor has a rapid strep test run and it is positive and gives him the diagnosis of strep throat (definitive diagnosis).

If the physician had to send the patient outside for tests and wait for resutls he could not definitively diagnosis him and would write "probable strep throat" but the coder can't code the step yet so they have to code the condition which is sore throat.

Does that help?

 

[Chaim]

My question is in regards to the difference between section 3 and section 4. It seems as if section 3 is saying even if it isn't definitive, still code as if it is. But instead of using the word diagnosis, they use the word condition in a synonymous manner with the word diagnosis.

 

[Laureen]

Oh I see what you are saying now - yes that is correct. For inpatient you can code it as if the physicians said they had it vs only suspecting it.

 

[Chaim]

Thanks

 

[CrystalVoxx]

ICD-9 Guidelines guides one has to how to correctly decode the things.