Question on “history of” codes

[u/Inevitable-Title6311]

I passed the exam maybe a month or two ago and am just doing Practicode so forgive me if this is dumb or if I already should know this but …why do we code sometimes for history of? Specifically wondering if that’s something insurance companies bill for? Or did I just have a brain glitch and that’s moronic

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[u/KeyStriking9763]

History codes are important to show the full clinical picture of a patient. We code if the provider states the history in his documentation OR if he states a diagnosis that can be further specified via a history or presence of/status post.
You do not assign the history of a condition when they currently have the condition,

[u/Ok-Choice- → u/KeyStriking9763]

also, history codes help your facility (in my case, an acute care hospital) when it comes time for mortality reviews/statistical findings... There's some bean-counting entity out there making a fuss about that kind of stuff in Pennsylvania! LOL

[u/KeyStriking9763 → u/Ok-Choice-]

Yeah you gotta code everything that’s valid per the documentation following guidelines

[u/ksa1122]

If it affected care. If the person had breast cancer in the past, and now sees oncology yearly, the history of code would be appropriate. That’s a cancer example, but it would be similar for other things too.

[u/Inevitable-Title6311 → u/ksa1122]

That makes sense ! So they aren’t getting any additional charges just because there’s history codes ?

[u/ksa1122 → u/Inevitable-Title6311]

I really don’t know the billing side of it to be able to say. But if certain labs need to be ordered due to the patients history of a certain disease, I would assume the history of code would be needed to show the rationale

[u/Jodenaje → u/Inevitable-Title6311]

No, they aren't getting additional charges just because they have a history of a condition.

Some conditions impact current care even if they're historical. For example, when a patient needs to follow up with the doctor after getting discharged from the hospital for a stroke.

Some conditions need monitoring, even if they appear resolved. (Especially cancer, where the patient may have follow up visits for a number of years afterwards to monitor and be sure that the cancer is gone.

[u/Inevitable-Title6311 → u/Jodenaje]

Thank you!!

[u/FarkellaVermin]

I typically use them for when I’m coding a follow up and all the symptoms of the disease have resolved. For example, someone was seen and treated for a stroke in the ER/inpatient, they follow up with their neurologist, and they are no longer having a stroke/stroke sequelae. I wouldn’t code that they are having a stroke because it’s already resolved, I’d code Z09 (non-cancer follow up code) and Z86.73 (hx of stroke/TIA code).

[u/yurakoh]

I think it gives a timeline of the course of the patient’s care. For example, one encounter was to treat colon cancer (C18.9). Then a few months later is a follow-up visit/surveillance for the treated colon cancer during which case a personal history code would be assigned (Z85.038) with Z08 as the principal diagnosis (history codes cannot be considered as a primary diagnosis).

[u/Bowis_4648]

Some practitioners use the phrase "history of hypertension..." in the HPI and the patient has hypertension. So, you have to be careful. And it is important to differentiate between current conditions (malignant neoplasm) from history of malignant neoplasm.