ICD-9-CM Medical Necessity

ICD-9-CM CODING MEDICAL NECESSITY FOR DIAGNOSIS

ICD-9-CM AND MEDICAL NECESSITY

Ø  LCDs and NCDs

Ø  2012 OIG Work Plan

Ø  Official Guidelines for Coding and Reporting

ICD-9-CM AND MEDICAL NECESSITY – COMMONLY MISSED DIAGNOSIS

Ø  Signs and symptoms when appropriate

Ø  Chronic diseases when treated or managed

Ø  V codes for other factors influencing health status

ICD-9-CM AND MEDICAL NECESSITY – FIRST LISTED DIAGNOSIS

Ø  List first the code for the diagnosis, condition, problem, or other reason shown to be chiefly responsible for the services provided

Ø  Codes that describe symptoms and signs, as opposed to diagnoses, are acceptable for reporting purposes when a diagnosis has not been established

Ø  List first the code for the diagnosis, condition, problem, or other reason shown to be chiefly responsible for the services provided

Ø  Codes that describe symptoms and signs, as opposed to diagnoses, are acceptable for reporting purposes when a diagnosis has not been established.

ICD-9-CM AND MEDICAL NECESSITY – ADDITIONAL DIAGNOSIS

Ø  Code all documented conditions that coexist and require or affect patient care treatment or management

Ø  Chronic diseases may be coded and reported as many times as the patient receives treatment and care for the condition

Ø  For outpatient encounters for diagnostic tests that have been interpreted by a physician, and the final report is available at the time of coding, code any confirmed or definitive diagnoses documented in the interpretation. Do not code related signs and symptoms as additional diagnoses.

            V58.6x Long-term (current) drug use

·        Continuous use of a prescribed drug for long-term therapy or prophylaxis

·        Do not assign for medication administered for a brief period to treat an acute illness/injury (e.g., course of antibiotics to treat acute bronchitis)