February 12, 2023February 17, 2023 When coding What do you code first? When coding What do you code first? Code First/Use Additional Code The ICD-10-CM coding convention requires the underlying condition be sequenced first followed by the manifestation. Wherever such a combination exists there is a “Use Additional Code” note at the etiology code, and a “Code First” note at the manifestation code. Do you code symptoms first? If signs and symptoms are associated routinely with a disease process, do not assign codes for them unless otherwise instructed by the classification. If signs and symptoms are not associated routinely with a disease process, go ahead and assign codes for them. How do you sequence ICD 10 codes? Coding conventions require the condition be sequenced first followed by the manifestation. Wherever such a combination exists, there is a “code first” note with the manifestation code and a “use additional code” note with the etiology code in ICD-10. Which of the following Z codes can be reported as a first listed code? A Z code is always the first listed code to report a newborn birth status. Z codes can be used in any healthcare setting. What is the proper order in which to select a diagnosis code? This convention instructs you to “Code first” the underlying condition, followed by etiology and/or manifestations. What is the procedure when the coder instructed to code first or code also? If there’s a “code first” note in the tabular, the coder needs to follow this instruction and sequence the underlying etiology or chronic disorder first followed by the manifestation as an added diagnosis. There will be a note depicting “use additional code” at the underlying condition/etiology. What is the guideline for coding signs and symptoms? Signs and symptoms are acceptable if no cause for them has been established by the provider. If there is a combination code that includes the symptom, an additional code for the symptom is not reported. An example is a patient with alcoholic hepatitis presenting with ascites. When should signs and symptoms be assigned as an additional code? Rationale: In the instance where a symptom(s) is followed by contrasting/comparative diagnoses, the symptom code is sequenced first. All the contrasting/comparative diagnoses should be coded as additional codes. 3. What order should diagnosis codes be listed? This is the primary diagnosis, and in most cases it should be listed first on the claim form, followed by codes that describe any coexisting conditions that affect patient care, treatment or management. What order do medical codes go in? This convention instructs you to “Code first” the underlying condition, followed by etiology and/or manifestations. Appears in the Official Guidelines at I.A. 13. The “Use additional” code note is found below the underlying condition code. Are there Z codes that are only first listed? Z Codes That May Only be Principal/First-Listed Diagnosis According to 2018 Guidelines section: 1;C.21.c.16, the following Z codes/categories may only be reported as the principal/first-listed diagnosis, except when there are multiple encounters on the same day and the medical records for the encounters are combined: When to use a Z code in healthcare? According to the chapter-specific guidelines for Chapter 21 ” Z codes are for use in any healthcare setting. Z codes may be used as either a first-listed (principal diagnosis code in the inpatient setting) or secondary code, depending on the circumstances of the encounter .” Can A Z code be used as a secondary code? Z codes may be used as either a first-listed (principal diagnosis code in the inpatient setting) or secondary code, depending on the circumstances of the encounter .” Can A Z code be reported only as a primary diagnosis? Some Z codes are reported only as a primary diagnosis. ICD-10-CM guidelines list which Z codes are reportable only as the first listed diagnosis, with exception (Note: Italics are added for emphasis, bold text is in the original guidelines): Questions