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Use of Primary Diagnoses in Homecare vs. Symptom Coding Guidance

Posted on Thursday, June 8, 2017 1:45 PM

There is an ongoing discussion going on in homecare coding concerning primary diagnoses. Differing choices or using symptom codes for a primary diagnosis is frowned upon currently. There is ICD-10 coding guidance that supports these choices in certain cases. Symptoms can be used as a primary diagnosis when no definitive diagnosis is available.  Even though many agencies refuse to use a symptom code as primary, the coding guidance supports the practice as long as the cause of the symptom is unknown or not stated. There can be differing opinions concerning the choice for primary diagnosis when more than one diagnosis meets the criteria without creating a coding error in certain cases. The 2017 official coding guidance supporting these coding options is stated below:

A. Codes for symptoms, signs, and ill-defined conditions codes for symptoms, signs, and ill-defined conditions from Chapter 18 are not to be used as principal diagnosis when a related definitive diagnosis has been established. (If no definitive diagnosis is present-code the symptom)

B. Two or more interrelated conditions, each potentially meeting the definition for principal diagnosis. When there are two or more interrelated conditions potentially meeting the definition of principal diagnosis, either condition may be sequenced first, unless the circumstances of the admission, the therapy provided, the Tabular List, or the Alphabetic Index indicate otherwise.

C. Two or more diagnoses that equally meet the definition for principal diagnosis In the unusual instance when two or more diagnoses equally meet the criteria for principal diagnosis as determined by the circumstances of admission, diagnostic workup and/or therapy provided, and the Alphabetic Index, Tabular List, or another coding guidelines does not provide sequencing direction, any one of the diagnoses may be sequenced first.

One should make every attempt to obtain the cause of symptoms to avoid using these as a primary diagnosis.  Keep in mind that the choice for primary diagnosis may differ when more than one diagnosis meets the criteria as primary as long as there is no mandatory sequencing applied in those cases.

Written by Mary Deakle, HCS-D, COS-C, Corridor’s Manager of Compliance & Education.

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