How to correctly assign the diagnosis code for speedy payment

Before you go any further just let me say that I know many of you will disagree with me. That is fine. Everyone whom I have tried to educate regarding the correct selection and use of both ICD and CPT codes has had tremendous difficulty because my method is so totally different than what other chiro ractic seminar resenters teach. If you ersevere and finally come to understand my method and rationale you will not have as many billings sent out for review and you will get aid faster with much less difficulty. Those that have tried my way agree with me. Insurance adjustors agree with me. INTRODUCTION The im ortance of ro er coding of a diagnosis cannot be overstressed. !ccuracy is essential to reimbursement for services rendered and to rotection from both mal ractice and civil litigation. In the ast several years" I have ersonally collected do#ens of diagnosis code lists $$ from doctors" software manufacturers" ractice management%advisory grou s and billing seminars. &ot one of these lists was written with the e'ce tions%e'clusions and s ecific re(uirements necessary to ro er coding. )ithout knowing the e'ce tions and e'clusions ertaining to a articular code it is almost certain that an incorrect code will be used on a large ercentage of atients. *et+s look at some e'am les, -.-./ brachial le'us com ression 10-.2 cervicalgia 10-.- cervicobrachial syndrome 104./0 lumbar s inal stenosis -.-.0 cervical root lesions 10-.0 cervicocranial syndrome 10-.3 cervical syndrome 104.. backache 5 ain6 syndrome

!ll of these are commonly used in many chiro ractic offices. 7owever" all of these 5and others6 are s ecifically e'cluded in any condition which is in any way disc related or involves s ondylosis 5osteoarthritis6. These 3 codes do not su ort chiro ractic mani ulation. It is easy to understand how a chiro ractor without this knowledge of e'ce tions may erroneously code an incorrect diagnosis. 8e eatedly making incorrect diagnoses can lead to roblems with the 9tate Board. 8emember" the doctor has the ultimate res onsibility. :sing a list full of mistakes and%or omissions is no e'cuse. !n incorrect diagnosis followed by re eated treatments may also lead to indefensible mal ractice charges. )ith the !mericans )ith Disabilities !ct more disabled ersons are filing !.D.!. claims. The &inth Circuit Court of ! eals has affirmed that a disabled erson can be sto ed from ursuing an !.D.!. claim because of the way an !TT;8&E< ;8 D;CT;8 documents the disability 5e.g. ina ro riate ICD$= code6" or because of the

manner in which the erson with the disability or the Doctor testifies at de osition" or both" !9 ! >!TTE8 ;? *!). 5@ennedy v. ! lause" Inc.6 In short" assign an ina ro riate code and you may be sued and forced to ay for the erson+s disabilityA 5By the way" they have all been B figure settlements" so far. >al ractice does not cover it.6 >any of the codes may be inter reted as a lying to more than one area with a slightly different descri tion relating that code to that anatomical area $$ such as 103.3." muscle s asm" thoracic myos asm" etc. In some cases there e'ists a considerable discretion as to the descri tion" in others there is none. ;nly with a code book can you be sure. These diagnoses were taken from CInternational Classification of DiseaseC =th 8evision" 4th Edition. Clinical >odification. Dolumes 2" 0" E - 2===. Definitions of terms were verified in Dorland+s >edical Dictionary. !lan *. *yons" D.C. >arch -2" 2===

In 2==3 the California 9tate Board of Chiro ractic E'aminers in(uired as to whether I would work with the !ttorney FeneralGs office" utting together a rosecution case against an CallegedC major chiro ractic clinic doing fraud. I agreed. >uch of what I am utting in my ICD article and in my CPT article is from my e' erience in this case. Do your ICD and CPT coding the way I e' lain it or you may end u the way the other clinic did. 59ee the !?ICC &ews H C>ajor ain clinic faces big trouble.C >edicare re(uires the use of ICD$=$C> and the CPT codes for reimbursement. The codes are mandatory. There are very s ecific rules that must be followed in the assigning of the codes. >edicare has historically set the recedent and standard which all other carriers follow. Frou insurance" 7>;+s" PP;+s" auto insurers and worker+s com ensation all follow the recedents set by >edicare. The use of ICD$=$C> and CPT codes is universal. )hat is the rimary reason we try to arrive at a diagnosisI >any doctors answer that we diagnose in order to get aid. ! good try" but incorrect. The ur ose of a diagnosis is to determine" to the highest ossible degree of accuracy" the C!:9E of the atientGs condition. ?irst a few definitions, 9ign, an observation about the atient. Includes" but not limited to, swelling" antalgia" toe dro " rash" bleeding" abnormal gait" ata'ia" a honia" dilated or constricted u ils" s asticity" discoloration" etc. 9ym tom, the atient+s com laint or descri tion of what they feel. Includes, ain" numbness" tingling" ringing in the ears" double vision" deafness" blindness" u set stomach" nausea" difficulty breathing" oor memory" difficulty slee ing" neuritis" radiculitis and all syndromes" etc.

9igns and sym toms are more generally called Cmanifestations.C Definitive diagnosis, the !CT:!* C!:9E of the atientGs condition. This is the goal of diagnosis. This is what the doctor treats. This is the justification for the doctor+s rocedures and for getting aid for those rocedures. ! definitive diagnosis" by definition" includes all signs and sym toms related to that diagnosis. Thus" in the resence of a definitive diagnosis the lesser s ecific signs and sym toms are s ecifically rohibited from inclusion in the diagnostic coding statement. If you include the signs and sym toms with the definitive cause the insurance com any com uter will kick the file out for human review and you will not get aid for months. The ur ose of arriving at a diagnosis is to determine the CAUS of the atient+s condition%sym tom. In diagnosing it is erfectly correct to use codes for signs and sym toms I? that is as close to a cause as the doctor can get. But signs and sym toms are vague and non$s ecific and therefore not a justification for chiro ractic mani ulation. ! medical doctor can medicate signs and sym toms. !n acu uncturist can a ly needles to alleviate them. But what can a chiro ractor doI 7e could a ly an ice ack. 7e cannot justify mani ulation in the absence of a diagnosis that is descri tive of a misalignment. Diagnoses that are descri tive of a misalignment are, sublu'ation" s rain%strain la'ity of ligament. 9omatic or segmental dysfunction does not su ort s ecific chiro ractic mani ulation. 9omatic or segmental dysfunction is a category Jnot elsewhere classifiedG which means that these diagnoses are vague and used Kwith ill$defined termsL and that a more e'act diagnosis is coded elsewhere. *a'ity of ligament is a chronic condition. The term chronic s rain is an o'ymoron in California+s workers com . In Muly of 2==1 the Industrial >edical Council defined a s rain and a sublu'ation each as an ACUT CONDITION. They also defined the acute hase as being the first thirty days from the date of injury and the chronic hase as after ninety days from the date of injury. The date of injury being day one. ?rom day -2 through day 3= ost$injury there is the subacute time eriod. I use the chronic diagnosis after day -/" since it is after the acute hase. )e do not have a diagnosis that su orts mani ulation other than acute or chronic ones. 9ince the diagnosis su orts the rocedures done on the atient" an acute diagnosis" by definition" does not su ort treatment outside the acute hase. )hen the insurance carriers finally reali#e this an awful lot of doctors are going to be out an awful lot of money. <ou cannot go back and alter the records at a later date to reflect a chronic diagnosis. !ltering the records is a crime. &euritis is an inflamed nerve. It is a diagnosis of ain. It is general and vague. It is not a diagnosis of the definitive C!:9E" but only of a sym tom. It is not descri tive of a misalignment and therefore does not su ort the chiro ractic mani ulation rocedure. >yelo athy is a general term denoting functional disturbances and%or athological changes in the s inal cord. It is also not descri tive of a misalignment. It is also not something a chiro ractor can treat.

9yndromes are s ecific sets of sym toms that occur together. >yofascitis is inflammation of the tendon sheath" es ecially at the insertion to the bone. It cannot even be determined on a >8I. It has to be diagnosed by bio sy or auto sy. Do not code a diagnosis you cannot rove or that you cannot treat. If a atient has a condition" such as osteoarthritis or disc herniation" list it in the Discussion section of your notes or re ort but do not assign it a code unless it is a com licating factor that must be taken into consideration in treating the rimary condition.. There may be legal ramifications for doing so. &ow comes the really difficult conce t for most chiro ractors. It is mandatory that you have an CEC code to end the coding statement. 9ometimes you >:9T have two CEC codes. The E codes are the e' lanation of how and where the injury occurred. The correct definition of E codes is, C9u lemental classification of e'ternal causes of injury and oisoning.C If the first E code is in the range of E33/ through E=03.3" you must have a second E code to denote the lace of occurrence 5geogra hic lace6. The lace of occurrence E codes are E34=./ through E34=.=. There are so many e'am les listed under each code I cannot begin to list them here. <ou really need a code book. )ithout the a ro riate E code5s6 the insurance com uter will kick your billing out for review. There are three more code lists that I am not going to attem t to e' lain here. If you think that what I have already resented is difficult to acce t" you sure donGt want to hear about the other lists. 9ome have in(uired as to when the ICD$2/ codes will re lace ICD$=. There is no date set as of yet. <ou had better ho e they never come into use. The ICD$2/ list is the most awful thing I have ever seen. It may take me years to figure it out. The ICD$= and CPT books may be urchased by calling 2$3//$>ED$97;P. &ote, These are my o inions" not taken from any coding reference or te't. E'am les of Correctly Coded Cases

2. >ale injured by a fall from a ladder at work today. Com laints of low back ain with grade - sciatica. E'am and '$ray reveal a right PI ilium and a *. sublu'ation with some ;!. !cute diagnosis 5N-2 days from the date of injury6 34B.2 sacroiliac ligament s rain%strain 34B./ lumbosacral s rain%strain 5*.$926 E332./ fall from a ladder

E34=.- lace of occurrence" industrial lace and remises &ote, It is the coder+s choice whether to use s rain%strain or sublu'ation codes. Chronic diagnosis 5O-/ days from the date of injury6 103.4 la'ity of ligament =/..1 late effects of s rain%strain w%o tendon injury E=0=.- late effects of accidental fall E332./ fall from a ladder E34=.- lace of occurrence" industrial lace and remises &ote, The =/..1 shows that 103.4 is the se(uela of 34B.2 and 34B./" not an unrelated and new diagnosis. The E codes tell the adjustor how and where the original injury occurred. Thus there is no need to hold u ayment until a re ort can be obtained from the rovider. 0. >ale" B/" no trauma. )oke u with com laints of low back ain" bilateral grade - sciatica. E'am and '$ray show 1/P loss of the *.$92 disk s ace height and a right PI ilium. >yos asm is intense. Posture and gait are antalgic. !mbulation is guarded. !cute diagnosis, 3-=.40 sublu'ation" sacroiliac joint E=03.3 other uns ecified environmental and accidental causes Chronic diagnosis, 103.4 la'ity of ligament E=03.3 other uns ecified environmental and accidental causes &ote, !n ilium sublu'ation diagnosis would be incorrect as it is an acute condition 5N-/ days from the date of injury6 and also the 103.4 would include a sublu'ation. It should be mentioned in the chart notes or in any re ort. &o diagnosis of disk degeneration should be made because it is a sign at this oint" not a roven definitive diagnosis of the cause of the sym toms in the absence of a >8I. It also would not su ort mani ulation. !fter a >8I demonstrating a bulge or herniation you would

add 100.- lumbar IDD disorder with myelo athy as a com licating factor. The la'ity of ligament su orts mani ulation" the disc does not.

-. ! B year old male is brought in by his arents. 7e resents with ost$ traumatic torticollis. !cute diagnosis, 341./ torticollis" acute traumatic E=01 overe'ertion and strenuous movements 5 laying6 E34= lace of occurrence" home &ote, There are 1 codes for torticollis. The correct code for an acute traumatic torticollis is 341./ cervical s rain%strain. Must change the descri tion if you want to. Trust me. Besides" it is the only torticollis code that su orts mani ulation. Chronic diagnosis, 103.4 la'ity of ligament =/..1 late effect of s rain%strain w%o tendon injury E=0=.3 late effect of other accident

4. ?emale" 4/ yo" tri E fall in a ark. Prior conditions of fibromyalgia" diffuse ;!" meno ausal. Presents with ain everywhere. E'am and '$rays reveal, sacroiliac" cervical" mid thoracic sublu'ations. !cute diagnosis, 34B.2 sacroiliac s ain%strain 341./ cervical s rain%strain 3-=.02 thoracic sublu'ation T1 5must s ecify level6 E33. fall on same level from sli ing" tri ing" stumbling. E34=.4 lace of occurrence" lace for recreation and s ort

&ote, It is the coder+s choice whether to use s rain%strain or sublu'ation. ! thoracic sublu'ation was given due to the low ain grade in this area according to the atient. The coding is for this acute injury only. The other com licating conditions must be mentioned" but should be mentioned in the discussion section of the re ort. If you code the com licating conditions they will most robably result in a delay of ayment. Chronic diagnosis, 103.4 la'ity of ligament =/..1 late effects of s rain%strain w%o tendon injury E=0=.- late effects of accidental fall E34=.4 lace of occurrence" lace for recreation and s ort &ote, E34=.4 is not technically re(uired in the chronic diagnosis in this case. It is re(uired if a code in the range of E33/ through E=03.= is used. I add it to give the adjustor more information.

.. >ale" ..yo" injured at work. 7e and another forklift o erator were both backing u and ran into each other. Patient resents with neck ain" right shoulder%arm ain" u er back myos asm. !cute diagnosis, 341./ cervical s rain%strain E34B accidents involving owered vehicles used solely within the buildings and remises of industrial or commercial establishment &ote, 9 rain%strain or sublu'ation diagnoses always include all radiculitis" neuritis" sym toms diagnoses. Chronic diagnosis, 103.4 la'ity of ligament =/..1 late effect of s rain%strain w%o tendon injury E=0=./ late effects of motor vehicle accident

B. >ale" B/yo" resents with head%face%neck ain. 7istory reveals systemic candidiasis with e'tensive destruction of facial bones. &o e'am or '$rays were done due to the e'tensive history related by the atient. Diagnosis, DB3.32 referral of atient w%o e'am or treatment &ote, Due to the oor rognosis for this ty e of disease" the risk of contagion and lack of success of rior and resent thera y this atient was not acce ted even for e'am. Thus" no diagnosis of candidiasis was made because no lab tests were done to confirm it. If the atient had been lying and a diagnosis of systemic candidiasis had been made lacking lab roof the rovider would be o en to lawsuit.

1. ! workcom atient" just discharged yesterday" returns to discuss e'ercises to strengthen the injured area. Diagnosis, DB..42 e'ercise counseling &ote, <es" it is a valid code.

3. ! erson in a motor vehicle accident is referred to you for a second o inion e'am. 5! very smart rimary treating doctor6 !n e'am is done" rior '$rays are reviewed and a re ort is done. Diagnosis, 5whatever diagnosis you arrive at should also be followed by D12.4 e'am of erson in motor vehicle accident. <ou >!< &;T also charge for reading the '$rays. <ou >!< also charge for the re ort or you may include that in the D12.46

=. ! discharged atient returns at a later date for a follow$u e'am. Diagnosis, 5in addition to your diagnosis you should add, DB1..= follow$u e'am following com leted treatment6

2/. ! atient needs a work limitation sli or a hysical education sli or any other ty e of medical certificate. Diagnosis, DB3./ issue of medical certificate &ote, >ay be used solely" if no other service is rovided" or with other services. &ot an absolutely necessary code if other services are rovided. 22. ! atient fails to com ly with or return for treatment. Diagnosis, D2..32 noncom liance with medical treatment &ote, !lways C<!. :se this code to rotect yourself from litigation when a atient fails to follow your recommended treatment rogram. <ou must also send the atient a letter stating the im ortance of continuing with your rogram. I would recommend certified mail with return recei t re(uested. Document all hone calls" too. <ou can be sued for atient abandonment for not educating the atient as to the im ortance for treatment and the otential conse(uences of sto ing treatment against your recommendations. 20. Patient returns ;&*< for a re ort of findings. Diagnosis, DB..4 re ort of findings &ote, In this case the re ort of findings must be the ;&*< service done on that day. 2-. ! &!9! tehnician tri s and is injured while working inside the s ace shuttle. !cute diagnosis, 5in addition to your diagnosis add, E34../ accident involving s acecraft" occu ant of s acecraft6 Chronic diagnosis, 5change acute to chronic codes. E34../ does not change6

24. Patient resents 0 months ost abdominal surgery. Com laining of abdominal and low back ain. Q$ray shows a surgical instrument left in the abdomen.

Diagnosis, E312./ foreign object left in body during surgical o eration &ote, If you intend to adjust this erson add a code to su adjustment. ort the

2.. >ale" 22yo" no sym toms. Parent re(uests a s inal checku . 7istory and e'am are unremarkable. Diagnosis, D1/.. e'am" school age child

2B. >ale" 22yo" com lains of low back ain. !fter a com rehensive e'am and '$rays you still have no idea what the cause is. Diagnosis, 1==.= diagnosis unknown 5also, unknown cause of morbidity6 &ote, &ot a good code to use if you want to treat. 21. Child is brought in after eating some of mother+s cosmetics. Child begins vomiting. Diagnosis, E3BB.1 oisoning by cosmetics The following guidelines for assigning diagnosis codes was e'tracted from 4./ ages in - reference te'ts. I tried to only get the material ertinent to the chiro ractor. GUIDELINES FOR USING ICD-9-CM CODES DIAGNOSIS CODES MUST SUPPORT PROCEDURE CODES Each service/procedure billed for a patient should be supported by a diagnosis that would substantiate those particular services or procedures as necessary in the investigation or treatment of their condition based on currently accepted standards of practice by the chiropractic profession. Some basic HCFA guidelines are summarized below. he focus is toward the guidelines that affect the chiropractor. !. "ndicate on the claim form or itemized statement the appropriate code#s$ from the "C%&'&C( code range ))!.) through *+,.' to

identify diagnoses- symptoms- conditions- complaints or other reason#s$ for the procedure- service or supply provided. A. Codes in the range ))!.) through '''.' are for the classification of diseases and in.uries. Codes that describe symptoms are only acceptable if that is the highest level of diagnostic certainty documented by the doctor. /. he codes *)!.) through *+,.' are to deal with visits for circumstances other than disease or in.ury. ,. The primary diagno i ho!"d #e "i $ed %ir $& Additional codes for any current coe0isting conditions are then listed. 1. "C%&'&C( codes should be listed at their highe $ "e'e" o% pe(i%i(i$y& A. 2se three digit codes only if there are no four digit codes within the coding category. /. 2se four digit codes only if there is no fifth digit subclassification for that category. C. 2se the fifth digit subclassification for those categories where it e0ists. A code with insufficient digits may cause a claim to be returned. 3. %iagnoses documented as 4probable4- 4suspected445uestionable4- or 4rule out4 should NE)ER be coded as if they were confirmed. 6. 7hen patients receive ancillary diagnostic services ONL* during an encounter- the appropriate 4* code4 for the service should be listed first- and the diagnosis or problem for which the services are being performed listed second. For e0ample- code *8,.69adiological e0amination- not elsewhere classified- describes the reason for the encounter and should be listed first on the claim form or statement. "f the reason for the referral is :nown- a second "C%& '&C( code which describes the signs or symptoms for which the e0amination was ordered should be listed. Failure to list a second "C%&'&C( code in addition to the * code may result in claim delays or denials.

;. Code all documented conditions that coe0ist at the time of the visit that RE+UIRE OR AFFECT patient care. %o not code conditions that no longer e0ist.

MEDICARE PENALTIES FOR NON-COMPLIANCE he penalties for non&compliance differ depending upon whether or not the health care professional has agreed to accept assignment or not. !. For health care professionals who accept assignment on a (edicare claim and who fail to include "C%&'&C( codes as re5uired will have their claim#s$ returned for proper coding and may be sub.ect to post&payment review by the (edicare intermediary- as well as payment denials. ,. For health care professionals who do not accept assignment- the penalties are more severe. A. "f the original claim form does not include "C%&'&C( codes- as re5uired- and the health care professional refuses to provide the codes promptly on re5uest to the (edicare intermediary- the professional may be sub.ect to a civil monetary penalty in an amount not to e0ceed <,-))).))- per claim. /. "f the health care professional continuously fails to provide the "C%&'&C( codes as re5uested- the professional may be barred from participation in the (edicare program for a period not to e0ceed five years. 1. For (edicare the service must be manual manipulation of the spine. his service is reported by procedure code A,))). 3. he primary diagnosis must be sublu0ation of the spine- either so stated or identified by a term descriptive of the sublu0ation. he following diagnoses are acceptable because they would always involve a sublu0ation= intervertebral disc disorders 8,,.)&8,,.' curvatures of the spine 818.)&818.' spondylolisthesis 81+.3&86;.!, spondylolysis 86;.!! 6. he level of sublu0ation must be stated.

DO,N CODING %own coding is the process of reducing a code from one of a higher value to one of a lower value which results in lower reimbursement.

7ith procedure coding- down coding claims is easily resolved by providing a procedure description which matches that of Current >rocedural erminology #C> $ e0actly- or- even better- by eliminating all procedure descriptions. For (edicare anyway. A :ey point to remember is that if there are any current coe0isting conditions which may COMPLICATE T-E TREATMENT FOR T-E PRIMAR* CONDITION. it is very important to include the "C%&'&C( codes for the coe0isting conditions which will help to .ustify the level of service provided. 7hen you use a screening code from the *&code section you should also code signs or symptoms. he reason is most health insurance carriers do not provide coverage for routine screening procedures or preventive medicine.

CODING IN/URIES Categories +))&'6' include fractures- dislocations- sprains and various other types of in.uries. "n.uries are classified first according to the general type of in.ury and within each type there is a further brea:down by anatomical site. "n cases of multiple in.uries- $he mo $ e'ere in0!ry i $he prin(ipa" diagno i & 2se the appropriate E&Code to identify the cause of the in.ury.

MANIFESTATIONS (anifestations are characteristic signs or symptoms of an illness. Signs and symptoms that point rather definitely to a given diagnosis are assigned to the appropriate chapter of "C%&'&C(. However- Chapter !;- encompassing categories 8+)&8''- includes ill&defined conditions and symptoms that may suggest two or more diseases or- may point to two or more systems of the bodyand are used in cases lac:ing the necessary study to ma:e a final diagnosis. E0amples= !. Cases for which no more specific diagnosis can be made even after all the facts bearing on the case have been investigated- for e0ample- code 8+3.) Headache. ,. Signs or symptoms e0isting at the time of the initial encounter that proved to be transient and whose cause could not be determined- for e0ample- code 8+)., Syncope and Collapse. 1. >rovisional diagnoses in a patient who failed to return for further investigation or care- for e0ample- code 8+;.6, >ainful 9espiration.

USING ) CODES *&codes are used to identify encounters with the health care setting for reason other than an illness or in.ury- for e0ample- immunization. *&codes are also used to identify encounters of persons who are in.ured or ill and whose in.ury or illness is influenced by some circumstance or problem classified to the *&codes. *&codes fall into one of three categories? problems- services or factual. !. >roblem *&codes identify a circumstance or problem that could affect a patient@s overall health status but is not itself a current illness or in.ury. Coding a drug allergy is an e0ample. ,. Service *&codes describe circumstances other than an illness or in.ury which prompt the patient@s visit. his type of visit often occurs when the patient has a chronic disease but is not acutely ill. An e0ample would be a patient with a :nown disc herniation who has sought a maintenance spinal manipulation. 1. Factual *&codes are used to describe certain facts that do not fall into the 4problem4 or 4service4 categories. For e0ample- coding the type of birth using code *1).! & Single Aiveborn prior to admission to hospital. *&codes can be used as a solo code- a principal code or as a secondary code. "t is important to use *&codes properly. "f a complication is present- the complication should be coded to categories ))!&8'' instead of to a *&code.

USING E CODES E&codes permit the classification of environmental events- circumstances and conditions as the cause of in.ury- poisoning and other adverse side effects. he use of E&codes together with the code identifying the in.ury or condition provides additional information of particular concern to industrial medicine- insurance carriers- national safety programs and public health agencies. he E&codes may be assigned with any of the codes in the main classification ))!&''' to identify the e0ternal cause of an in.ury or condition. E&codes are NE)ER used as solo codes or as principal diagnostic codes. E&codes are important for providing details of an accident to an insurance company to enable them to issue faster and more accurate reimbursement. Since most insurance carriers wait to be sure they reimburse only for services covered under their policy and not for services covered under 7or:er@s Compensation or Automobile/Homeowner@s insurance. A clear understanding of the circumstances will eliminate 5uestions from the insurance carrier which cause delays in reimbursements. 7hen using E&codes always list the E&codes as secondary or supplemental to the code#s$ describing the in.ury.

Coding E1amp"e2 Fractured ribs due to fall from ladder at home. +)8.)) Fracture of ribs- closed- unspecified E++!.) Fall fom ladder E+3'.) >lace of occurrence- home

CODING LATE EFFECTS Bou use late effects coding when coding diagnostic statements that identify a residual effect #condition produced$ after the acute phase of an illness or in.ury has ended. he proper coding se5uence is the code number identifying the residual #the current condition$ to be listed first with the code number identifying the cause #original illness/in.ury no longer present in its acute phase but which was the cause of the long term residual condition listed second. An appropriate late effects E Code should be used- where possible- for in.uries. Cther late effects codes may be found in the (iscellaneous section #')6&')'$. /e sure to distinguish between a late effect and a historical statement in a diagnosis. 7henever the statement uses the terms 4effects of old...-4 4se5uela of...-4 or 4residuals of...-4 then code as late effects. "f the diagnosis is e0pressed in terms as 4history of...-4 these are coded to personal history of the illness or in.ury and are coded to the *&Codes #*&!) to *&!'$.

ACUTE AND C-RONIC CODING !. "f there are separate subentries for acute- subacute and chronicthen use both codes se5uencing the code for the acute condition first. ,. "f there are no subentries to identify acute- subacte or chronicignore these ad.ectives when selecting the code for the particular condition. 1. "f a certain condition is described as a subacute condition and the inde0 does not provide a subentry designating subacute- then code the condition as if it were acute.

In pa$ien$ 3i$h m!"$ip"e epara$e in0!rie ea(h epara$e in0!ry m! $ ha'e a (omp"e$e"y epara$e diagno $i( $a$emen$& Code $he mo $ erio! in0!ry %ir $&

A44RE)IATIONS NOS Dot Ctherwise Specified. E5uivalent to 2nspecified. his abbreviation refers to a lac: of sufficient detail in the statement of diagnosis to be able to assign it to a more specific subdivision within the classification. NEC Dot Elsewhere Classified. 2sed with ill&defined terms to alert the coder that a specific form of the condition is classified differently. he category number for the term including the DEC is to be used only when the coder lac:s the information necessary to code the term to a more specific category. Each office should have a copy of the current year@s "C%&'&C( and the C> code boo:s. hese may be ordered by calling !&+))&(E%&SHC>. As: for "C%&'& C( Hospital Edition- *olumes !-, E 1 #! boo:$- Color Coded and thumb inde0ed and the current year@s C> code boo:- >rofessional Edition. Another e0cellent boo: to have is 9eimbursement (anual For he (edical Cffice- A Comprehensive Fuide o Coding- /illing E Fee (anagement- hird Edition. " recommend the yearly purchase of the "C% E C> boo:s. Since we chiropractors manipulate the articulations of the body- the only diagnoses that would support our manipulation would have to be descriptive of a misalignment. 9emember- the %"AFDCS"S (2S S2>>C9 HE >9CCE%29E. CA E %%% complicate a patient@s condition but it is the misalignment #sublu0ation$ that we manipulate. Stic: to using diagnosis codes you can defend.

9incerely" D8. !*!& *. *<;&9" D.C. !"alified #edical $al"ator Independent #edical %aminer Certified Disability $al"ator Diplomate and Certified %pert in Chiropractic Claims Re$iew &ellow' Academy of &orensic and Ind"strial Chiropractic Cons"ltants Diplomate and Senior Disability Analyst' American (oard of Disability Analysts )ast #ember' Northern California &ra"d In$estigators Association' *++, - *++.

(oard Certified %pert in Tra"matic Stress' Diplomate' The American Academy of %perts in Tra"matic Stress #ember' State Compensation Ins"rance &"nd )referred )ro$ider Networ/