Question

What is not coded once a diagnosis has been Ssigned to the patient?

Answer 1

Once the diagnosis is assigned to the patient, signs, and symptoms should not be added to the code. Medical coders should be expert in coding and should keep the coding rules in mind. The coding should include the confirmed diagnosis and associated symptom. For example, if the patient had complaints of pain in the right lower quadrant and diagnoses as acute appendicitis, the coder should report as K35.3- Acute appendicitis with localized peritonitis. Another example, If the patient has chest pain code specifically as R07.9 - chest pain unspecified.