tci ED Coding & Reimbursement Alert - 2004 Issue 11

Reader Question: Check Chart for Combo Code

Question: A patient with blood in her stool and diverticulosis presented in the ED. The physician's documentation does not specifically link the two conditions, but I am wondering whether I should report 562.12 (Diverticulosis of colon with hemorrhage). Computer edits keep telling me that if the doctor doesn't say the bleeding doesn't come from the diverticulosis, I need to report the combination code. What is correct?Montana Subscriber Answer: Your solution is correct - you should indeed code to the highest degree of specificity. Unless the physician documentation specifically states that the gastrointestinal lesion is not the cause...

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