Co-morbidity diagnosis codes

[gaspasser127]

---

Members don't see this ad.

When seeing patients in clinic let’s say you saw a patient with back and leg pain, signed them up for an epidural, gave some meds - and it was a pretty focused visit.

The patient has a PMHx of CAD, HTN, DM, etc etc

When you put in your diagnosis codes before closing out the encounter, do you only put in lumbar radiculopathy and other codes relevant to the pain your addressed or do you also include diagnosis codes for those comorbid conditions like CAD and HTN even if not addressed in the visit.

Is there a reason to include these codes?

 

[VA Hopeful Dr]

Don't add codes unless you either address them or they will impact your plan

You won't manage a fib, for instance, but the anticoagulant they are on for that will matter if you're going to do an injection so that's worth mentioning. Or diabetes if you're giving any type of steroid.

 

[Ducttape]

you have to address the other comorbid condition to be able to add that to your diagnosis codes.

 

[gaspasser127]

This was my assumption as well.

I’m being told by admin that adding the codes (even if not addressed during the visit or impact the plan) are used by insurance companies to determine how complex a patient is when they’re comparing your healthcare expenditure compared to a peer.

Any truth to this?

 

[Ducttape]

no idea.

but you might consider using code G2211.

https://www.cms.gov/files/document/mm13473-how-use-office-and-outpatient-evaluation-and-management-visit-complexity-add-code-g2211.pdf

 

[callmeanesthesia]

This was my assumption as well.

I’m being told by admin that adding the codes (even if not addressed during the visit or impact the plan) are used by insurance companies to determine how complex a patient is when they’re comparing your healthcare expenditure compared to a peer.

Any truth to this?

It does affect your risk-adjusted cost of care for MIPS. However, we were told that as long as they have a PCP or specialist managing that condition within the calendar year the comorbidities will count even if not in your note.

 

[clubdeac]

I add it to my impression and diagnosis codes and then I talk about risks of injection with the identifiable risk factors (DM II, HTN, Afib on Coumadin, CHF, immunosuppressant therapy like skyrizi which everyone is on b/c of increased risk of infection etc.) This is worth mentioning b/c then the risk for an epidural reaches a level 4 and not just a level 3

- minor surgery with identifiable risk factors or however it's worded