Coding Diagnostic Versus Therapeutic Procedures

on Tuesday, 14 July 2020. All News Items | FAQ

Inpatient FAQ July 2020

Q:

What are the determining factors for when a procedure is performed for diagnostic versus therapeutic purposes?


A:

First, determine the objective of the procedure.  Is the procedure performed to:  

  • Make a diagnosis, or
  • Eliminate a condition?

For example, a physician may remove all necrotic tissue that is present in a slow healing wound.  A sample of that tissue was sent to pathology to see what organisms may be growing. This would be a therapeutic removal of tissue as the objective was to remove all of the necrosis to promote wound healing.

Another example is found in Coding Clinic, Third Quarter 2017, page 12, which addresses the coding of abdominal paracentesis. The advice found here tells us to use the qualifier ‘Z’ if there is a therapeutic component to the procedure (0W9G3ZZ, Drainage of Peritoneal Cavity, Percutaneous Approach).  The physician may send a fluid sample to pathology to look for malignant cells or leukocytes. However, the objective of the paracentesis is to relieve the pain and discomfort from ascites, which is a therapeutic procedure.

It is important to note that if both a diagnostic and therapeutic paracentesis are performed separately, then both should be coded.

Biopsies are good examples of diagnostic procedures, such as, a pancreas biopsy in a patient with a pancreatic mass or bone marrow biopsy for unexplained anemia.

Article by Anita Meyers

Anita Meyers, RHIT, CCS, AHIMA-approved ICD-10 Trainer is an Inpatient Coding Professional at Medical Management Plus, Inc.  Anita has over twenty-six years of experience in inpatient and outpatient coding including 17 years of work at AQAF reviewing inpatient and outpatient records from Alabama hospitals.  In addition to reviewing records she was the team leader in Beneficiary Services where she participated in case review activities, received and processed beneficiary complaints and handled fee-for-service denials for home health, hospice and skilled nursing facility services.  Prior to joining the MMP, Inc. team, Anita left AQAF to become an inpatient contract coder and worked at various hospitals in central Alabama. In her current position, Anita is an integral part of the Inpatient Services at Medical Management Plus, Inc. You may contact Anita at This email address is being protected from spambots. You need JavaScript enabled to view it.

This material was compiled to share information.  MMP, Inc. is not offering legal advice.  Every reasonable effort has been taken to ensure the information is accurate and useful.

 

 

 

 

 

 

 

 

 

 

green-iconWe are an environmentally conscious company, dedicated to living “green” both at work and as individuals.

Location

home-icon
1900 Twentieth Avenue South
Suite 220
Birmingham, AL 35209

Connect

phone
205-941-1105
phone
800-592-9639
email
This email address is being protected from spambots. You need JavaScript enabled to view it.

 

 mhms