Tuesday, February 23, 2016

Coding CHF

Q: When acute congestive heart failure with preserved ejection fraction (EF), instead of diastolic or systolic is documented how do I code this?  The physician's are saying the heart failure is not diastolic or systolic. What is the best way to approach this issue?

A: This is very common. The term “preserved EF” in general equates to a diastolic heart failure. But, as you clearly understand, we cannot apply the code for the diastolic heart failure with the use of that verbiage.

The descriptions of diastolic and systolic in categorizing heart failure are older terms, and the code set has not yet “caught up” to the new wording. I encouraged my providers to state “diastolic heart failure with preserved EF.” This documentation gives coders what they need, and allows physicians to use clinically-accepted language.

AHA’s Coding Clinic for ICD-10-CM, First Quarter, 2014 speaks to this. It provides two examples. First, can heart failure with preserved EF or heart failure with preserved systolic function be coded as diastolic heart failure? Second, can heart failure with reduced EF, heart failure with low EF, or heart failure with reduced systolic function (or other similar terms) be coded as systolic heart failure?

Coding Clinic says “no” to these situations. The coder cannot assume either diastolic, systolic failure, or a combination of both, so CDI specialists need to query the provider to clarify the type of heart failure.

We cannot capture the acuity of heart failure without the descriptor of diastolic or systolic being stated. So, the last piece of advice is to educate providers about the importance of capturing specificity particularly in light of measuring severity of illness and risk of mortality, as this could influence their own quality scores. This may help to influence their cooperation with providing the needed clarification.  

Friday, February 5, 2016

AHIMA: Take Advantage of External Cause Codes Discussion


Should we use initial or subsequent when a patient returns the same or next day to the ER for fracture care/issues?

Injury Extensions

Most categories in chapter 19 have seventh character extensions that are required for each applicable code, and most categories have three extensions (with the exception of fractures):
  • A, Initial encounter
  • D, Subsequent encounter
  • S, Sequela
Extensions for initial encounters are used while the patient is receiving active treatment for the injury (e.g., surgical treatment, emergency department encounter, and evaluation and treatment by a new physician). The extensions for subsequent encounters are used for encounters after the patient has received active treatment of the injury and is receiving routine care for the injury during the healing or recovery phase (e.g., cast change or removal, removal of external of internal fixation device, medication adjustment, other aftercare and follow-up visits following injury treatment).

Zika Virus Coding Advice

Per the Centers for Disease Control and Prevention (CDC), the correct code for confirmed Zika virus infection is A92.8, Other specified mosquito-borne viral fevers.
Further guidance on correct coding in various clinical scenarios will be forthcoming from the CDC and posted on the CDC website. The information and the link to the CDC website will be disseminated by AHIMA as soon as it is available.

Monday, January 4, 2016

Important Interim Advice from NCHS on Excludes1 Notes

* The National Center for Health Statistics (NCHS) posted interim advice that provided additional clarification of circumstances where some conditions included in Excludes1 notes should be allowed to both be coded.
* If the two conditions are not related to one another, it is permissible to report both codes despite the presence of an Excludes1 note.
– Example: Excludes1 note at code range R40-R46 states that symptoms and signs constituting part of a pattern of mental disorder (F01-F99) cannot be assigned with the R40-R46 codes.
– If a Bipolar patient is experiencing dizziness unrelated to bipolar R42 may be coded.

* Due to a partial code freeze, changes to Excludes notes or revisions to the official coding guidelines cannot be made until October 1, 2016. This new guidance for Excludes1 notes is intended to allow conditions to be reported together when appropriate.

Wednesday, October 7, 2015

Welcome to the New Blog

Ladies and gentlemen,

We are officially in go-live mode with ICD-10.  So congratulations for making it across the "starting line."  But, now the real work begins.  This blog is intended to help connect MSHIMA members to one another for the sharing of lessons learned and best-practices for ICD-10.

So, please enjoy this blog.