To the Editor:

In “Seven Tips to Improve Your ICD-9 Coding for Diagnostic Tests” [Getting Paid, February 2002, page 16], you advise reporting unrelated and coexisting conditions/diagnoses as secondary diagnoses, for example, in the case of a patient with chronic hypertension and diabetes who presents with a cough and whose subsequent X-ray indicates pneumonia. In the example given, would you report pneumonia, hypertension and diabetes? Obviously not at the initial visit if the patient’s presenting symptom is a cough. Does your example pertain to follow-up visits or diagnostic testing? Would you code co-existing conditions if you are not treating them?

Author’s response:

Consistent with the first point in the article (“Code the confirmed diagnosis whenever possible”), you should code pneumonia at whatever point it is confirmed. Thus, if the patient has a chest X-ray while in the office for the initial visit, and your interpretation of the X-ray confirms that the patient has pneumonia, then you could report pneumonia at that encounter as a confirmed diagnosis.

If you simply order the X-ray at the initial visit, then, as you noted, you could not code pneumonia at that encounter since it has not been confirmed. Rather, you would have to code “cough” as the sign or symptom that prompted ordering the X-ray, which was the second point in the article (“If there’s no confirmed diagnosis … code the signs and symptoms that prompted you to order the test”). Use of the diagnosis of pneumonia would have to await the results of the X-ray and would be applicable to follow-up visits or subsequent diagnostic testing, as you suggested.

In either case, you could report hypertension and diabetes as unrelated, co-existing conditions even if they are not being treated during the encounter. For example, you might want to report them to highlight the complexity of the patient’s situation, help justify the plan of treatment ordered for the pneumonia, etc.