F07.81 - Postconcussional Syndrome

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JJones
Posts: 45
Joined: Sat Dec 20, 2014 9:32 pm

Wed Sep 20, 2017 9:12 am

Hello! Has anyone received a denial when using the F07.81 alone?

One of our coders recently did, due to the "Code First" note under F06 which states to "Code first the underlying physiological condition". (There is no mention of "if applicable" to this note, making it sound as though there should be a first listed code.)

Our understanding of post-concussion syndrome is that it is a series of symptoms (headaches, dizziness, loss of concentration, insomnia, blurry vision, changes in behavior, etc.) caused by a concussion. Based on this understanding, the cause is already in the code description, so this would not apply.

The note at the end of F07.81 states to "Use additional code to identify associated post-traumatic headache, if applicable". Is it possible that because this syndrome is typically diagnosed when the patient continues to feel at least three of the symptoms listed below that those symptoms are to be listed in addition to the F07.81? That does not seem correct either.
Post-concussion syndrome
Medical condition
Post-concussion syndrome, or post-concussive syndrome (PCS), refers to the lingering symptoms following a concussion or a mild traumatic brain injury (TBI). It is typically diagnosed when a person who has recently suffered a head injury continues to feel at least three of the main symptoms following a concussion. These include dizziness, fatigue, and headaches.

Healthline
Thank you,
JJones
brooke.querry
Posts: 12
Joined: Tue Jun 20, 2017 3:32 pm

Thu Sep 21, 2017 3:28 pm

F07.81 has a code first note: code first the underlying physiological condition. It sounds like they want the injury code primary.
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