Assigning Other Diagnoses, section III Coding Guidelines
There are some differing opinions in our organization regarding to the Coding Guidelines. Section III. Reporting Additional Diagnoses state:
For reporting purposes the definition for "other diagnoses" is interpreted as additional conditions that affect patient care in terms of requiring:
- Clinical evaluation; or
- therapeutic treatment; or
- diagnostic procedures; or
- extended length of hospital stay; or
- increased nursing care and/or monitoring
There is one argument that if a diagnosis does not meet any of the above criteria, it should not be coded - even if documented.
On the other hand, I.A.19 states, "The assignment of a diagnosis code is based on the provider's diagnostic statement that a condition exists. The provider's statement that the patient has a particular condition is sufficient. Code assignment is not based on clinical criteria used by the provider to establish the diagnosis.
So, the discussion is that if a physician documents a condition - even if it doesn't meet the definition for "other diagnoses" it should be coded...
The other side is, it should not be coded if it doesn't meet the definition for "other diagnoses".
Just wanted some outside thoughts on this.