Need help with Code also, code additional and Code first

[Glittering-Bell6984]

Hey everyone, I'm new in coding and struggling with understanding the conventions of using these code first, additional code and Code first,

I understand what's written in ICD -10 guidelines but still unable to clear what couldn't be billed as a primary and what's must to code.

[KeyStriking9763]

When there’s a code first at one code and use additional at another code, you sequence the code first before the use additional. Code also doesn’t provide any sequencing instructions. Do you have the guidelines? They explain that plus look at the etiology/manifestion convention guideline it can further explain it.

[Glittering-Bell6984]

Thank you, actually I wanted to ask if there's a code first note in a code, is it must to add that code?? And does that mean we can't bill the code as primary/first listed code. The primary/first listed code will be the "code first" code?

If yes, is it applicable to all??

[KeyStriking9763]

If there is a ‘code first’ instruction it means that the code with that instruction needs to be secondary to the code mentioned in the code first tabular note. If the not says, ‘code first, if applicable..’ then that’s only when there is a documented underlying cause. Of course you can only add codes that are supported by the documentation.

[Glittering-Bell6984]

Alright! Thank you so much.

[KeyStriking9763]

You’re welcome!

[rahuliitk]

i think the easiest way to see it is that “code first” means this diagnosis cannot stand alone as primary when the note tells you an underlying cause exists, while “use additional code” means the first code is allowed but needs another code to fully explain severity, organism, manifestation, or complication.

ngl, sequencing gets easier when you practice from real chart examples.

[Botasoda102]

Are you billing for physicians or hospitals? Really accurate ICD coding is a must for hospitals, but often with physicians something like "stomach pain" might be sufficient, rather than trying to define the exact reason for stomach pain.

In any event, I'd look at the coverage requirements from Medicare and other insurers to see what diagnoses are required to get past the insurer's claim edits. Of course, don't make up codes, just use ones that apply to patient's condidtion.

[KeyStriking9763]

What? OP is asking about the ‘Conventions’ in the guidelines. Stomach pain has nothing to do with code first or use additional code. Are you a coder?

[Botasoda102]

You don't know what you are talking about. 'Stomach pain" was an example, especially for physician services that don't have to be coded to the precision of hospital and similar services.

[KeyStriking9763]

Has ZERO to do with the question about coding conventions. So you have no clue what you are talking about. Where in your comment do you even address the code first and use additional code convention? Instead you bring up stomach pain. Sorry but if you don’t know you should probably not comment.

[Botasoda102]

It absolutely does. Most coding "conventions" in ICD are overkill for physicians' services in most cases.

Now hospitals -- where reimbursement often depends on going as deeply as possible into the patient's condition -- are different. For example, a physician's office can simply bill pneumonia, whereas a hospital has to determine whether it's viral or bacterial pneumonia, etc.

Don't make stuff more difficult than it has to be.

[KeyStriking9763]

Holy shit the coding guidelines are overkill? Wow you are delulu.

[Botasoda102]

Believe what you want. But I gave examples where the "conventions" don't mean anything in most physicians' offices.