Q: | When an MRA patient has several diabetic manifestations, do I need to report all the diabetic codes even though there is a hierarchy? |
A: |
Yes, and the creation of combo codes in ICD-10-CM makes coding multiple diabetic manifestations much easier. (Check out our blog on Combination Codes) There are a few reasons why you should code them all, assuming they were all assessed at the visit. In this case, the assessment of the patient’s health includes all the manifestations. A coder’s job is to translate all the manifestations into their correct codes. Second, the progress note is a legal document that should reflect the health of the patient on that date of service. Consequently, all the diagnoses assessed by the provider should be included. Third, from a risk adjusted standpoint, there is a hierarchy in that diabetes with chronic complications trumps diabetes without complications. However, it now makes no difference if the patient has one or three diabetic complications; the payment for diabetes remains the same. The bigger issue is that some of the complications are themselves risk adjusted diagnoses. So the bottom line is that you should report everything the clinician assessed and documented correctly. |