Code Assignment and Clinical Criteria

2017 ICD-10-CM guidelines – “Code assignment and clinical criteria” Update:

Code assignment and clinical criteria:

The assignment of a diagnosis code is based on the provider’s diagnostic statement that the 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.

Instructions to coders and CDSs:

We always code based on narrative diagnosis documentation from the physician when the documentation appears reliable.

We never code from clinical criteria or clinical indicators alone.

Coders and CDSs must continue to review records to ensure that documentation/clinical indicators support the stated diagnoses.

There must be appropriate clinical criteria/indicators before a query can be initiated.

Instances of potentially unreliable documentation must continue to be addressed per Tenet policy.