Cracking the Code

Reporting an Additional Diagnosis with a Combination Diagnosis Code

It can be confusing for medical coders to know when it is appropriate to report an additional diagnosis when a combination diagnosis code is already reported. When reporting a combination diagnosis code, instructions in the tabular index may state “use additional code to identify specific condition”. The keyword in this guidance is SPECIFIC. If the documentation does not provide specificity, then the additional diagnosis is NOT appropriate for reporting along with the combination diagnosis code.

Anemia was specified, so the additional diagnosis is reported. Obesity was not specified, so only the pregnancy diagnosis for obesity is reported.

Q: A 28-year-old obese woman comes into the ED with complaints of fatigue and weakness. She is currently 24 weeks pregnant. The physician orders a CBC, which results with a final impression of iron deficiency anemia. Upon discharge, the physician counsels the patient about taking prenatal vitamins daily and maintaining a healthy diet. Final diagnoses: obesity and anemia.
A: O99.012, anemia complicating pregnancy, second trimester
D50.9, iron deficiency anemia
O99.212, obesity complicating pregnancy, second trimester
Reference: AHA Coding Clinic Third Quarter 2018, page 4 and First Quarter 2017, page 25
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