"Bill First"

[Debbie C]

Is there a rule of thumb to which code should be billed first if the ICD 9 does not state otherwise? for example 250.40 and 585.3, I understand that, but maybe a good example might be dehydration due to flu. What is the rule to "bill first". My thinking is, you would have the flu before the dehydration, but then my over thinking kicks in and thinks that you woudn't maybe have an office visit if you weren't dehydrated. Thank you for your help on this biggie

 

[Alicia Scott]

If your guidelines do not state you can go by which dx is listed first by the physician. Off the top of my head I was thinking there was something on higher number vs smaller. Maybe someone can jump in and clarify. It just escapes me at the moment.

 

[Carolyn Heath]

The first thing that pops in my mind are these two questions: What did the patient come in for? Why is the patient there? I was taught about these two questions when I took my coding class. These questions are good to ask yourself when trying to list a first diagnosis. If you could answer those two questions, you will have your answer. The patient came in to see the doctor because they were dehydrated and had the flu. So, the physician wrote "dehydration due to flu." You will code for dehydration as a first-listed diagnosis and flu as a secondary diagnosis. Did I explain it right, Alicia?

 

[Debbie C]

Makes sense to me. So, the reason patient is being seen, dehydration, is the first code since that is the actual reason for the visit, right?

 

[Carolyn Heath]

Correct! And the cause for the dehydration is the flu which would be your second diagnosis.

 

[Ruth Sheets]

This post was also answered during the November 2012 Q&A Webinar. Your may view the replay of this video, as well as all the replays from the past, when you join the CCO Club. For more information, click here.

 

[Ruth Sheets]

I'm paraphrasing the transcript from the Nov 2012 Q&A Webinar where Laureen answered the question...

Laureen did a search on Findacode.com: typed in dehydration and it brought her to 276.51. The plain English description helped her. It described what dehydration and had a note… “Note: Since dehydration is usually the result of another underlying condition like the flu, either of which may require medical management in itself. Determining code sequencing can be difficult.”
And then the note goes on to say, “It may be listed first when the physician documents that the dehydration is mainly responsible for the visit and treatment is directed at correcting it.”

Laureen: So my general rule of thumb for outpatient coding is think about the reason they came in the door. What’s their chief complaint? And if that turns into you know, a diagnosis... maybe their chief complaint was sore throat and it ends up being they have strep throat, you would code that strep throat. In addition, too, maybe they also have the flu or whatever.

So I don’t think you could go wrong with having either first, the flu or the dehydration for outpatient and physician-based coding. But, we’d have to see the documentation to really make a determination which it seemed that the physician focused in on. If most of the documentation seemed to be about the dehydration and the medical decision making was about dehydration, how to get the patient rehydrated… maybe they were so bad, he or she may need to go to the hospital. So that’s what you really should use to help you make that decision.

Some other references are the official ICD coding guidelines. Another is also this great article online I found in doing some research on advanced review the official outpatient ICD-9-CM coding and reporting guidelines. This will be in the transcript for the CCO Club members. But it is on advanceweb.com. You could probably Google for it. And it talks here about first listed diagnoses. I really thought this was really good info here. It’s related to CCS Prep but it applies to anyone learning ICD coding.

 

[Carolyn Heath]

I am familiar with advanceweb.com. I used Advance for Health Information Mangement which is part of advanceweb. It is a good resource and it also have a practical skill building for ICD-10.

 

[Michele]

Thanks for the info about advanceweb.com - I will add it to my favorites for future reference!