tci ED Coding & Reimbursement Alert - 2024 Issue Q3

Reader Questions: Be Careful With Complexity for Undiagnosed Condition

Question: Does an undiagnosed new problem with uncertain diagnosis automatically mean a moderate level of problem complexity? Minnesota Subscriber Answer: It really depends on the situation and the documentation, but not much is “automatic” when it comes to leveling an encounter. Confusion here revolves around the different ways ICD-10-CM and CPT® operate in regard to uncertain diagnoses. With ICD-10-CM, you are bound by Guideline IV.H, which tells you not to document a condition as “as ‘probable,’ ‘suspected,’ ‘questionable,’ ‘rule out,’ ‘compatible with,’ ‘consistent with,&rsquo...

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