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Post symptom codes
Author: reidymd
Date: Sep 18, 2008 9:35 am
I have heard a hundred times to use symptom codes but not really sure what this means. Has anyone read the Symptoms, Signs, and Ill-Defined Conditions section (codes 780-800) of the ICD-9? Most of the "symptoms" are practically diagnoses, ie "shortness of breath" means you've varified hypoxia, while "dyspnea" doesn't but excludes hyperventilation. Some (like sx of urinary retention) require that you also give the cause first. I am wondering if the purpose of this advise is really to direct us all to the pain codes (338's, but they don't cover all pains) or simply to make sure that our diagnosis is different than everyone elses? And then what if they use a "symptom" code?



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Re:symptom codes (by SharolHerr on 09/19/2008)
I have looked up 786.05, shortness of breath, and did not find any mention of hypoxia. We have been using the symptom codes for many years and not had any difficulty with billing. We have also not known other specialist to use symptom codes, they almost always use disease codes.
Re:symptom codes (by PCaines on 09/23/2008)
The below reply comment is provided on behalf of:

Julie Pipke, CPC
Reimbursement Manager, Medicine
Medical College of Wisconsin

Yes you are correct; the idea is to not use the ICD-9 code that relates to the terminal illness/disease unless there is nothing else. As you know PC providers are not treating the terminal illness/disease but are instead treating the typical by products of the disease which is usually helping patients cope with pain, depression, nausea-vomiting, fatigue, shortness of breath, altered mental status etc. If another provider of the same specialty also bills their service with the same sign/symptom code there is no recourse for getting payment as the services would be considered related.

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