Changes to ICD-10-CM Uncertain Diagnosis Revision

On Oct. 1, 2019, the official 2020 ICD-10-CM guidelines officially updated the terms that are now considered Uncertain Diagnosis:

“Do not code diagnoses documented as “probable,” “suspected,” “questionable,” “rule out,” “compatible with,” “consistent with,” or “working diagnosis” or other similar terms indicating uncertainty. Rather, code the condition(s) to the highest degree of certainty for that encounter/visit, such as symptoms, signs, abnormal test results, or other reason for the visit.”

With this change, ICD and CMS mandate the assignment of sign/symptom diagnosis codes rather than the code that describes the “consistent with” disease or condition. Pathology practices and independent laboratories must review and revise report templates in efforts to eliminate the use of these terms. Additionally, coding policies should be updated to address the assignment of diagnosis codes based on signs, symptoms, etc. if these terms are utilized in final pathology diagnoses.