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  • Unknown Diagnosis

    What diagnosis should we use when we are not sure of the diagnosis?


    From the ICD-10 Chapter in the Academy’s Fundamentals of Ophthalmic Coding

    Rule 3. Do not code “probable,” “suspected” or “rule out” conditions until they are established 

    This principle applies to lid lesions for which you do not have confirmed pathology. Lid neoplasms can be coded as benign, malignant, carcinoma in situ, uncertain behavior, or unspecified nature.

    There is no diagnosis code for “rule out.” It is very important that you do not indicate to the insurance company a disease or problem that you know the patient does not have. Thus, the appropriate codes should be related to what you do know —signs, symptoms, complaints, existing systemic disease and so on. 

    Bottom line: Never code a diagnosis that you are looking for. Only code what the patient actually has.