Q&A ICD-9 clarification

[Lisa Becker]

I came across 2 scenarios on practice tests that I didn't understand. They are:
#1
Patient comes into Dr. office with fatigue and weakness. Dr diagnosis is anemia, luecopenia and thrombocytopenia amd pancytopenia.

The answer was 284.1. Why does this code include all of the these diagnoses and why wouldn't you code each one?
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#2

Patient comes into Dr. office with cough and a fever. Final diagnosis: URI and pharyngitis.
The answer was 462

Why not 465.9 & 462?

Thanks!

 

[Ruth Sheets]

Remember the ICD-9-CM Guideline I.B.7: Conditions that are an integral part of a disease process. Signs and symptoms that are associated routinely with a disease process should not be assigned as additional codes, unless otherwise instructed by the classification.

If you look up the symptoms of pancytopenia, you will find the following symptoms mentioned, as well as others:
fatigue, weakness, anemia, thrombocytopenia and reduced white blood cells (aka leucopenia). Since all of these symptoms are part of the disease pancytopenia, you would code 284.1x. Code 284.1 requires a fifth digit, so the answer given is not correct, actually. If there was no other information you would code 284.19.

For the #2 question, cough and fever are symptoms of pharyngitis. Pharyngitis is an upper respiratory infection so you do not code URI separately. Code 462 is all you need.

So you have to be mindful of the symptoms of a disease and not code separately symptoms that are included in the disease.
This is easy to do when you have access to the internet, not so easy when you are taking an exam and some disease is being coded that you are unfamiliar with.

Probably if you have an idea of the symptoms of well known diseases such as pneumonia, stroke, mononucleosis, common cold, etc. you will be able to pick the proper multiple choice answer on the real CPC Exam. After all, AAPC does not expect medical coders to be doctors and know every symptom of every disease, so know the guidelines about this, and you will be able to answer the questions correctly.