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ICD 9 code for "Presumed" or "Consistent with" Diagnosis

Donna m Posted Tue 28th of January, 2014 19:37:32 PM

The provider states PRESUMED Adenocarcinoma of Peritoneal Carcinomatosis. It is our understanding we can not code a "Presumed" or "Consistent with" to the location so have been using a 199.1 ( unspecified) ICD 9 code for these type of Diagnosis. Is that correct? I could not really find anything in the ICD 9 guidelines about coding a "presumed" or "consistent with" diagnosis BUT ICD 10 does have a statement in the front of the neoplasm section regarding presumed.
Thank you for your help.

SuperCoder Answered Wed 29th of January, 2014 16:55:35 PM


SuperCoder Answered Thu 30th of January, 2014 16:22:57 PM

From ICD official guidelines :

Please check under section C of 10.1.1 - Determining the Appropriate Primary ICD-9-CM Diagnosis Code
for Diagnostic Tests Ordered Due to Signs and/or Symptoms
(Rev. 1, 10-01-03)

Diagnosis Preceded by Words that Indicate Uncertainty
If the results of the diagnostic test are normal or nondiagnostic and the referring physician
records a diagnosis preceded by words that indicate uncertainty (e.g., probably, suspected,
questionable, rule out, or working), then the interpreting physician should not code the
referring diagnosis. Rather the interpreting physician should report the sign(s) or
symptom(s) that prompted the study. Diagnoses labeled as uncertain are considered by the
ICD-9-CM Coding Guidelines as unconfirmed and should not be reported. This is
consistent with the requirement to code the diagnosis to the highest degree of certainty. EXAMPLE: A patient is referred to a radiologist for a chest x-ray with a diagnosis
of “rule out pneumonia.” The radiologist performs a chest x-ray, and
the results are normal. The radiologist should report the sign(s) or
symptom(s) that prompted the test (e.g., cough).

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