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tci Medicare Compliance & Reimbursement - 2007 Issue 23

ICD-9: Don't Make Up Your Own Extra Digit For Incomplete ICD-9 Codes

No diagnosis? No problem, Code signs and symptoms -- and get paid.In the absence of a confirmed diagnosis, you should report signs and symptoms--and you should expect to get paid. When your physician confirms a diagnosis, you have to use that ICD-9 code, according to program memorandum AB-01-144 from 2002. But when your physician doesn't specify a diagnosis, you should report the patient's signs and symptoms, coding experts say.ICD-9 coding rules state that you can't use a "rule-out" diagnosis on claims, says Kim Garner Huey, a consultant with KGG Coding and Reimbursement Consulting in Auburn, AL. You...

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