Question

I need to reply to these posts:

1.Conditions that are not an integral part of the disease is something that is not normally a part of the condition or diagnosis. Integral means that it is pertaining to the diagnosis and usually occurs with that diagnosis or condition.

Example: Patient comes in with complaints of having a constant fever, a diagnosis of the influenza virus was made. Only the influenza virus J11.1 is coded because a fever is integral to the diagnosis.

2.When a physician confirms a diagnosis, such as hypothyroidism, and the patient presents with fatigue, hair loss and/or inability to lose weight you would not code the symptoms because the diagnosis is confirmed and already explains the symptoms the patient is presenting for. Therefore the symptoms are no longer integral to the code. The code for Hypothyroidism would be coded as E03.9 Hypothyroidism, unspecified.

Answer 1

#. Conditions Integral Part of a Disease Process

codes for symptoms, signs, and ill-defined conditions are not to be reported as diagnosis when a related definitive diagnosis has been established, unless otherwise instructed by the classification. If you are unsure query the physician.

#. Conditions Not an Integral Part of a Disease Process

code for signs and symptoms that are not routinely associated with other definite diagnosis should be separately reported.