Diagnosis in PMH

Is it customary to query for a diagnosis only mentioned in the PMH? For example CHF-for type and acuity. Of course it is obvious that it is chronic if it is only mentioned in the PMH. It will not even be coded if only mentioned as past medical history. Another example is COPD-only mentioned in the PMH. My coding supervisor says not to query if it has no bearing on the current admission, but I think all these chronic diagnosis do have a bearing on a patient's condition even if stable at the time. Please tell me what you think. Thanks.


Martha Stanley, RN, MSN, CCDS
San Juan Reg Med Center

Comments

  • edited May 2016
    This is a very fine line and needs to be approached carefully and truly depends on the individual case.

    My opinion is that if the condition is being treated as part of the current encounter, for example oral diuretics for the CHF or nebulizers for the COPD, then it should be captured since resources are being used and care is being provided for those conditions.

    However if the condition is not being treated, does the condition impacting the providers medical decision making and guiding the treatment of the condition the patient is admitted for? It is always worth a discussion with the provider to ask that question. If the history impacts their medical decision making then they should document that and if not, at least you've had a good discussion with the provider and it may be in their mind for future encounters.

    Robert

    Robert S. Hodges, BSN, MSN, RN, CCDS
    Clinical Documentation Improvement Specialist
    Aleda E. Lutz VAMC
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  • I agree. I think it is appropriate to query if it is being treated.

    Katy Good, RN, BSN, CCDS, CCS
    Clinical Documentation Program Coordinator
    AHIMA Approved ICD-10CM/PCS Trainer
    Flagstaff Medical Center
    Kathryn.Good@nahealth.com
    Cell: 928.814.9404

  • It is a principle of coding that all chronic conditions that qualify for reporting per the UHDDS definition of a reportable conditions are coded. There is no need to query for something such as COPD that is documented in H&P. Your coding supervisor may mean 'there is no need to query' as these conditions WILL be coded?

    However, for something such as CHF, a query to define the type/acuity may impact the coding, ROM, and DRG Assignment.

    We should bear in mind that a condition does NOT have to be directly treated with a medication in order to satisfy the UHDDS definition of a secondary condition.

    (Example: Pt has 'diet-controlled' Type 2 DM, and does not take medications. The patient is placed on a diabetic diet and his B.S. is monitored in order to ensure his B.S. remains controlled - no meds are given, but the 250.00 is reportable because the DM was monitored.)

    AHA Coding Clinic
  • Thank you so much for all your posts especially the reference to the coding clinics-very helpful!
  • Good answer, Paul. I encourage all of my colleagues to know by heart the definition of a principal diagnosis AND a reportable secondary diagnosis. Also familiarize yourself with quality measures, public reporting, and risk adjusted mortality indices (RAMI) in order to educate the MDs why it is in everyone's best interest to clearly state any co-morbid conditions for which treatment/resources are being used, even if it is only home meds. Giving home meds includes nursing, pharmacy and potentially lab. Those are resources!
    Sandy Beatty
  • How about a patient with gi bleed where the doctor says that 5 months ago an EGD showed grade I vericose veins but then he does not mention them in his diagnostic impression for the current adm. Should I query?
  • edited May 2016
    Are the 'varicose veins' impacting this admission? Any treatment at this time?


    If the condition is being treated, evaluated, monitoring or increases nursing care you may use as a secondary diagnosis.





    Charlene Thiry RN, BSN, CPC, CCDS
    Clinical Documentation Specialist
    Quality Resources
    Menorah Medical Center




  • edited May 2016
    If it does not impact this admission, no query necessary.

    Charlene


  • Thank you for helping me think it through. My reasoning was that a patient with a GI bleed and varicose veins would be at a higher ROM than just a plain GI bleed patient. But I guess I was reading too much into it. Just the fact that it was not evaluated or treated on this current admission means that it would not qualify as a secondary diagnosis. Thank you so much for helping me think it through!
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