Coding Tip: Reporting additional diagnoses in the outpatient setting

Are you one of those coding professionals who anxiously awaits the quarterly release of AHA Coding Clinic? There’s nothing like that feeling when you open the latest issue and read through the latest and greatest nuggets of wisdom. It is like a box of chocolates; you never know what you’re going to get! Sometimes it’s like Coding Clinic has been reading your mind and perfectly answers that burning question you have had. 

And sometimes Coding Clinic confuses the heck out of us. 

One such Coding Clinic was Third Quarter 2020, p. 33, which instructs that we should not report mental health conditions for patients in the ED “unless the provider indicates these conditions (or any other condition) affected the management of the patient during the current visit.” This resulted in a collective scratching of heads. What?! Don’t report a condition that we know the patient has that we just know could impact the patient’s care? It just didn’t seem to make sense. 

It took several subsequent Coding Clinic clarifications to finally understand what this guidance was trying to teach us. The issue wasn’t related to the patient having the condition or even that the patient was being managed with medication for the condition. The issue was that the provider had not indicated that the condition affected management of the patient during that encounter. 

Presumably, coding professionals had been using their own judgment in deciding which chronic conditions were pertinent to the encounter rather than leaving that up to the provider. 

Coding Clinic Third Quarter 2021, pp. 32-33, Reporting additional diagnoses in outpatient setting – clarification did a good job of bringing this point home. It says:

“Coding professionals should not assign codes based solely on diagnoses noted in the history, problem list and/or a medication list. It is the provider’s responsibility to document that the chronic condition affected care and management of the patient for that encounter.” 

And with that clarification we finally got to that satisfying chewy caramel center of understanding. 

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