A primary-care follow-up addresses a healing surgical wound infection after an appendectomy performed weeks ago at a hospital. What should the physician-office coder report?
Select an answer to reveal the explanation.
Short Explanation
This is a clinic visit for a wound infection after surgery—not a redo of the hospital's procedure codes. Stick to the infection diagnosis for the professional claim and leave ICD-10-PCS to the facility that did the appendectomy.
Full Explanation
CCS-P professional-fee coding uses ICD-10-CM diagnoses (and CPT/HCPCS procedures when performed by the physician). ICD-10-PCS is the facility inpatient procedure system and is not assigned on the physician claim to recreate prior hospital surgery. The ambulatory focus is the postprocedural wound infection (or related complication concept) documented at today's visit. Coding the historical uncomplicated appendicitis alone or omitting the infection misstates medical necessity for the follow-up care.