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Question: A 6-year-old patient was seen for abdominal pain, diarrhea, and nausea with vomiting. My provider did a thorough exam and diagnosed the patient with unspecified infectious gastroenteritis. My coworker trained me to submit claims with the symptoms in order of severity, so the nausea with vomiting was first, followed by diarrhea, then the abdominal pain, then the gastroenteritis. The claim was later denied, but I can鈥檛 figure out why. Can you help?

RCI Subscriber

Answer: Yes, the first issue with the way the claim was submitted is sequencing. The principal diagnosis should be sequenced first, according to ICD-10-CM Official Guidelines. Although it is true that the patient presented with a series of symptoms, the provider determined the principal cause of the patient鈥檚 symptoms to be gastroenteritis, so that is what should be sequenced first on the claim. ICD-10-CM Official Guidelines Section II.A explains, 鈥淐odes for symptoms, signs, and ill-defined conditions from Chapter 18 are not to be used as principal diagnosis when a related definitive diagnosis has been established.鈥� This means that you should first report the primary diagnosis of gastroenteritis, possibly as A09 (Infectious gastroenteritis and colitis, unspecified). The rest of the symptoms should then be reported in their order of severity to help offer a comprehensive picture of the patient鈥檚 condition. So, in this sense, your coworker was correct, but because a diagnosis was found, the symptoms are coded after the diagnosis.

If A09 is the best code to use for this encounter, be cautious of the Excludes1 note, which advises against reporting A09 with Diarrhea NOS. This means that you cannot report A09 and R19.7 (Diarrhea, unspecified) together. Additionally, according to ICD-10-CM coding guideline I.C.18.a., when the practitioner diagnoses stomach pain that implies a disease process, you should only use an R10.- code if the stomach pain is not routinely 鈥渁ssociated with a disease process.鈥�

When you resubmit your claim, it should only need to include the following:

• A09
• R11.- (Nausea and vomiting).

Lindsey Bush, BA, MA, CPC, Development Editor, AAPC