Unspecified diagnosis codes often wreak havoc on cashflow because many payers simply deny them, said Thomas. “We need to be as specific and compliant as possible. That’s one of the reasons why we moved to ICD-10,” she said. Thomas discussed these seven diagnoses and provided checklists of what physicians should document to avoid denials: 1. Anemia • Any association with chemotherapy, neoplasms, drugs, chronic kidney disease, end-stage renal disease, or other chronic disease, when applicable • Due to bleeding (including the site), when applicable • Specificity (i.e., acute, chronic, or acute on chronic) •Type (e.g., deficiency, aplastic, pernicious, or postoperative) 2. Asthma • Any related tobacco use, dependence, or exposure • Any chronic signs and symptoms • Medication noncompliance, when applicable • Presence of chronic obstructive pulmonary disease or bronchitis, when applicable • Severity (i.e., mild intermittent, mild persistent, moderate persistent, or severe persistent) • Triggers or environmental risk factors • With or without acute exacerbation 3. Bronchitis • Type (i.e., acute or chronic) • Infectious agent (i.e., viral, bacterial, or obstructive) • Associated conditions/contributing factors (e.g., influenza, pneumonia, or emphysema), when applicable • Tobacco use, abuse, dependence, or exposure, when applicable 4. Chronic obstructive pulmonary disease • Body mass index • Smoking status, including history of smoking, when applicable • Use of home oxygen, BIPAP, or CPAP, when applicable • With acute exacerbation, hypoxemia, bronchitis, asthma, emphysema, or upper respiratory infection, when applicable 5. Congestive heart failure • History of myocardial infarction, coronary artery bypass graft, or smoking, when applicable • Medication noncompliance, when applicable • Presence of heart disease, bradycardia, heart block/type, arrhythmia, or diabetes, when applicable • Severity (i.e., acute, chronic, or acute on chronic) • Type (i.e., systolic, diastolic, left, right) • Use of home oxygen, when applicable • With hypertension or renal failure, when applicable 6. Diabetes • Long-term insulin use, when applicable • Manifestations and complications (e.g., nephropathy, retinopathy, osteomyelitis, and vascular disease), when applicable • Medication noncompliance, when applicable • Presence of secondary diabetes and cause (e.g., due to neoplasm, steroid-induced, or adverse effect of drugs), when applicable • Relationship between diabetes and cellulitis, when present • Type (i.e., Type 1 or Type 2) 7. Hypertension • Exposure to environmental tobacco smoke, when applicable • History of myocardial infarction, coronary artery bypass graft, or any other cardiac condition, when applicable • Medication noncompliance, when applicable • Relationship with chronic kidney disease, congestive heart failure, or both, when applicable • Tobacco dependence, use, or history of tobacco use, when applicable • Type (i.e., emergency, urgency, or crisis) Source
