"Rule-out" diagnoses (R/O)

Q: "How do I code for 'rule out' diagnoses?"

 

A:  Don't.

  • In practice clinicians use this (incorrectly) when they are unwilling to commit to a particular diagnosis. 
  • There is no "rule out" modifier in DSM nomenclature.   
  • Actually there's no way that "rule out" could be considered a diagnosis. 
  • A diagnosis is a declarative statement. 
  • By adding the modifier "rule out" you change the declarative statement into an intended future action. 
  • The first chapter in DSM entitled "Use of the Manual" it covers this topic in detail.  
Instead, use:

 

Provisional - when there is a strong presumption that the full criteria will ultimately be met for a disorder, but not enough information is available to make a firm diagnosis.

 

Not otherwise specified (NOS) - when there is insufficient opportunity for complete data collection but there is enough information to place the disorder within a particular diagnostic class

 

Unspecified Mental Disorder-non psychotic  ( 300.9 ) - this is appropriate when there is enough information available to rule out a psychotic disorder but further specification is not possible

 

Diagnosis deferred  ( 799.9 ) - if their information is inadequate to make any diagnostic judgment

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Common ICD-9

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