tci Medicare Compliance & Reimbursement - 2019 Issue Q3

Reader Question: Use ICD-10-CM Codes for Signs and Symptoms

Question: We have a coder who wants to hold charts when patients don’t have definitive diagnoses. She says the patient will have a definite diagnosis “down the line” and she will code them at that point. I’m urging her to submit the claims using signs and symptoms codes. Can you advise? New York Subscriber Answer: You are correct. In the absence of a definitive diagnosis, you should report signs and symptoms to support medical necessity for services a physician provides, in situations such as the following: The physician cannot make a more specific diagnosis, even after...

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