Hydrocephalus, to code or not to code?

morris-jeff@CooperHealth.edu

Recently we were told not to code hydrocephalus in a patient who has a VP shunt as the "hydrocephalus isn't present anymore", just wondering what others do. I know congenital malformations that have been corrected should be coded as a history of but has the hydrocephalus really been corrected? If the catheter kinks or malfunctions then the hydrocephalus is there to cause issues and revisions and/or replacements must be made. We were advised just to code the VP shunt status.

I just wanted to get everyone's thoughts/advice as our coders have always coded the hydrocephalus and the VP shunt status. It's kind of like asthma, copd, chf, etc.. the condition really isn't going to go away and the patient is always monitored for it.

Thanks in Advance,

Jeff

cmclose@saintfrancis.com

Good topic!

HCP is captured here as a 2nd dx.

Be interesting to see what other facilities/CDIs do.

Thanks Jeff!

Claudine

evanspx@sutterhealth.org

It is my understanding VP shunting redirects the fluid away from the brain to other anatomical sites, relieving pressure, but not 'curing' the hydrocephalus.  Jeff: I'd suggest a search of related medical sites to determine if this is the prevailing philosophy of Subject Matter Experts on this condition. 

 What I am saying is:   I code the hydrocephalus as it my felling it is not 'cured', but being managed with this device. 

I'd be interested to see if there are other thoughts - in particular, Jeff...who stated to you the presence of a shunt indicates the condition is 'always cured?  Also, there are other forms of this disease in addition to congenital forms.  At the very least,  if a VP shunt is present, examine any radiological studies that demonstrate support for the condition before making a blanket decision that the presence of VP means one can 'never' code the disease.  

An analogy would be a pt S/P Ablation of SA node for Atrial Fibrillation that continues to experience episode of A-Fib after the procedure...the A- Fib is not cured.

Reference: In this Scenario offered by AHA, a pt S/P shunt for hydrocephalus is coded with the Dx of hydrocephalus, Obstructive

Coding Clinic:  4th Q 1993

Question: The patient is a 48-year-old woman with a history of acquired aqueductal stenosis and ventriculoperitioneal (VP) shunt status since age fifteen with multiple revisions. She was transferred to the LTCH with residual focal neurological deficit and left-sided weakness, following shunt revision during acute care stay. The patient also received IV antibiotics for postoperative Staphylococcus aureus wound infection, and external surgical wound dehiscence. The physician felt that the residual focal neurological deficit could be rehabilitated and the patient was admitted to the long term care hospital specifically for rehabilitative services (i.e., physical and occupational therapy) with ongoing conditioning. How should this be coded?

Answer: Assign code V57.89, Other specified rehabilitation procedure, as the principal diagnosis. Since the patient was admitted to the long term care hospital specifically for rehabilitative services, code V57.89 is appropriately assigned as the principal diagnosis. Codes 998.32, Disruption of external operation wound, 331.4 Obstructive hydrocephalus, 998.59, Other Postoperative infection, 041.11, Staphylococcus aureus, V09.0, Infection with microorganisms resistant to penicillins, and V45.2, Presence of cerebrospinal fluid drainage device, should be assigned as additional diagnoses. Assign codes 93.39, Other physical therapy and 93.83, Occupational therapy, for the therapy provided.

morris-jeff@CooperHealth.edu

Correct Paul, 
I've always viewed a shunt as a treatment for hydrocephalus as it certainly isn't curative any more than lasix/dig cures chf or hemodialysis cures ESRD. I've never seen any advice not to code the hydrocephalus. Thanks for the coding clinic, will definitely use this when discussing the case with the person making this recommendation.

I was always under the assumption that you code chronic conditions & will also discuss with this person. I will tell you that no special workup was done related to the hydrocephalus was performed this admit as the pt was admitted with DKA. To me, being told not to code the hydrocephalus in this case equates to being told not to code DM or HTN on a pt admitted for an unrelated condition just because they are well controlled on meds.

interested to hear others opinions too

jeff

proy@chw.org

Our facility codes it as well.  It's still present.

morris-jeff@CooperHealth.edu

I've submitted to Coding Clinic, just waiting on their reply. Someone replied to the blog post by Kati & said they'd submitted to Coding Clinic before & I'd love to get a copy of their response to Pat's question. Proy, are you Pat that responded to the blog? If so, please email me jwmorris@health.southalabama.edu

Thanks, 
Jeff

evanspx@sutterhealth.org

Interesting discussion of an advanced topic...certainly would like know final outcome.  

Paul

morris-jeff@CooperHealth.edu

Here's Coding Clinic's reply:

It would be appropriate to assign a code for the hydrocephalus in addition to code

Z98.2, Presence of cerebrospinal fluid drainage device, for ventriculoperitoneal shunt

status due to hydrocephalus. Although the hydrocephalus is being controlled by the VP

shunt, the condition is still present.

The patient has a chronic condition, which will require some form of clinical evaluation

and/or monitoring. The shunt is draining the fluid, thereby eliminating a buildup of fluid in

the patient.

gracenote1953

I also code both the hydrocephalus and presence of VP shunt for the same reasons as mentioned above in others' comments.

afrady@blr.com

Just as a follow up.    Please caution users from taking one coding clinic rule (IE, the coding clinic stating you do not report Sick Sinus Syndrome and  if a pace maker has been placed and no meds are given) and then applying it to an unrelated situation.  Case in point, I have never met a coder who applied that rule to Hydrocephalus as the previous advice had been to actually report hydrocephalus.  

Coding clinics are very inconsistent in their rationale and you need to always double to check to make sure the one you are citing most closely reflects the situation being considered (which is not always easy).

evanspx@sutterhealth.org

I think the analogy I cited is entirely appropriate.  Particularly since I cited the specific Official Coding Clinic advice pertaining to hydrocephalus s/p placement of VP Shunt.   Agree Coding Clinic can be maddeningly and consistently inconsistent. I also think that we are all responsible to know how to research and use advice for Coding Clinic as professionals.
Paul Evans, RHIA, CCDS

hblawless

I appreciate the insight on this issue. Thank you to all of the contributors and view points. This was a difficult topic and I now I have a way to proceed. 

spitlerj@childrensdayton.org

Hey Jeff,

We code the hydrocephalus here at DCH. I also look for when patients are admitted with shunt malfunction if the patient is having signs of "compression of the brain". That is a query opportunity.

Jorde

Shannon.DiSilvestro

https://forums.acdis.org/discussion/3596/hydrocephalus-to-code-or-not-to-code

I agree with this statement, " I code the hydrocephalus as it my felling it is not 'cured', but being managed with this device."

We still code it here. With the the same line of thinking as to why we still code SSS in an even though they have an AICD/Pacemaker. The hydrocephalus would return if the shunt malfunctioned or was removed. The hydrocephalus was not "cured".

Shannon M. DiSilvestro (Sifuentes) BSN,RN, CCDS

Clinical Documentation Specialist

The University of Chicago Medicine

5841 S. Maryland Ave. | Rm. W-020, B-04 | Chicago, IL

Office: 773-702-4074

Mobile: 773-571-3629

Shannon.DiSilvestro@uchicagomedicine.org

spitlerj@childrensdayton.org

Great topic that comes up now and then. I agree, we code the hydrocephalus after the shunt placement because the shunt is the treatment and if it were to fail, they would need to revise the shunt.

Thanks,

Jorde

morris-jeff@CooperHealth.edu

https://forums.acdis.org/discussion/comment/21320#Comment_21320

Can't believe this thread is still alive from 2016 :-)