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Cracking the Code

The Importance of Reporting Chronic Conditions

Coders must understand the importance of reporting chronic conditions as secondary diagnoses for medical encounters. Per section III of the coding guidelines, the definition for “other diagnoses” is interpreted as additional conditions that affect patient care in terms of requiring: clinical evaluation; or therapeutic treatment; or diagnostic procedures; or extended length of hospital stay; or increased nursing care and/or monitoring. Chronic diseases are treated on an ongoing basis. They may be coded and reported as many times as the patient receives treatment and care for the conditions.

If a provider has conditions listed in their documentation that do not have bearing on the current visit, then these conditions should NOT be reported as secondary diagnoses. However, if there are conditions listed and documentation supports the patient taking long-term medication to treat these conditions, then it is appropriate for a coder to report them for that medical encounter.

Q: A 42-year-old male with history of GERD, HTN, and bronchitis presents to the ED with complaints of runny nose, cough, and sore throat. Patient is on daily medication of Prilosec and Lisinopril. Provider orders a swab test and results return positive for nasopharyngitis. After provider counsels the patient about their prescriptions, the patient is discharged home.
A: J00, acute nasopharyngitis, K21.9, gastro-esophageal reflux disease without esophagitis, and I10, essential (primary) hypertension
Reference: ICD-10-CM Official Guidelines for Coding and Reporting FY2022 Section III

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