pulmonary edema with ESRD and CHF

dwalker2

Advice please! I have a patient that presented from outpatient dialysis without having received HD due to low BP. When she arrived in the ED she was SOB and had frothy clear sputum. She does have a history of CHF. It was stated that her acute pulmonary edema was nephrogenic and was treated with HD. What is the principal diagnosis? pulmonary edema? ESRD? other?

Unknown

Fluid overload due to a missed dialysis? Maybe? Possibly query?

Jamie Dugan RN
Clinical Documentation Improvement Specialist
Baptist Health System
office:904-202-4345
cellular: 904-237-7253
Business Email-jamie.dugan@bmcjax.com
cdis.icd10@bmcjax.com

robert.hodges2

I'm thinking the acute pulmonary edema would be the PDx since that is what the patient sought treatment for. Secondary would be the end stage renal disease. Just my thoughts, but when in doubt query.

Robert

Robert S. Hodges, BSN, MSN, RN, CCDS
Clinical Documentation Improvement Specialist
Aleda E. Lutz VAMC
Mail Code 136
1500 Weiss Street
Saginaw MI 48602

cynthia.a.goewey

I too would think the acute pulmonary edema. There are coding clinics for fluid overload due to noncompliance with dialysis but this pt was not non-compliant and the doctor clearly stated pulmonary edema was nephrogenic and not cardiac so wouldn't use CHF.
Cindy

Unknown

Good point!

Jamie Dugan RN
Clinical Documentation Improvement Specialist
Baptist Health System
office:904-202-4345
cellular: 904-237-7253
Business Email-jamie.dugan@bmcjax.com
cdis.icd10@bmcjax.com

lprescott

We suffer with this one quite frequently and it's effects on core measures often leave the physicians very frustrated. The physician sees it as not CHF but I believe it codes to acute chf. i would love to know how other do this.

Laurie L. Prescott RN, MSN, CCDS

carmella.gay

The physician would have to specify that it was "of noncardiac origin" in order to code it separately from the CHF. Refer to CC 3rd quarter, 1988 page 3 to 4.

Carmella

blefevre

We have many cases of ESRD patients in pulmonary edema/ fluid overload that go to the CHF diagnosis upon coding the chart. Can anyone provide a copy of this Coding Clinic 3rd quarter, 1988 page 3 to 4 ?
Thank you

carmella.gay

I'm sorry, I guess I just assume everybody has access to coding clinics. Please see below for the coding clinic I was referencing. Also, if your facility has the 3M encoder you could probably get your IT department to put a stand alone version on your PC. The stand alone software has the encoder and a suite of other valuable information, such as coding clinics. I use it daily. And, it never hurts to ask for it. I would feel certain that your coders have access to either an electronic or paper version of coding clinic.

Carmella


Pulmonary edema, acute of cardiac origin
      Coding Clinic, Third Quarter 1988 Page: 3
      Related Information


Acute Pulmonary Edema of Cardiac Origin

Acute pulmonary edema of cardiac origin is a manifestation of heart failure, category 428.0-428.1, and, as such, is included in the following code assignments:

· Left ventricular failure, 428.1

· Congestive heart failure, 428.0

· Right heart failure secondary to left heart failure, 428.0

· Hypertensive heart disease - See 402.0, 402.1, and 402.9 with fifth digit 1

· Rheumatic heart disease, acute, 391.8

· Rheumatic active chorea, 392.0

· Rheumatic heart disease or chorea, inactive, chronic or quiescent, 398.91

· Rheumatic disease of heart valves (394-396), code also 398.91

Note from 3M:
As of October 1, 1994, code 414.0 has been expanded to fifth digits to indicate specific site of coronary atherosclerosis.


Note from 3M:
As of October 1,1989, category 410 has been expanded to fifth digits to indicate episode of care. Refer to Coding Clinic, Fourth Quarter, 1992 pg 24 for discussion on episode of care./line As of October 1, 1989, code 411.8 has been expanded to fifth digits to indicate specific forms of ischemic heart disease.


Acute myocardial infarction, 410.1-410.9, acute or subacute ischemic heart disease, 411.0-411.8, or coronary atherosclerosis, 414.0 and 414.8, with mention of acute pulmonary edema, refers to that with left ventricular failure, 428.1, excluding pulmonary edema with mention of congestive heart failure (428.0) or decompensated left ventricular failure (428.0).

Acute pulmonary edema with congestive heart failure due to or associated with nonrheumatic and nonhypertensive heart disease is assigned to 428.0 (left heart failure followed by right heart failure).

Documentation in the medical record of a patient with acute pulmonary edema of cardiogenic origin usually references cardiac enlargement, presence of S-3 gallop, elevated pulmonary artery wedge pressure, or associated cardiac diseases. The chest x-ray will frequently show pleural effusions and the presence of Kerley B lines. Treatment often includes diuretics and other cardiac medications.


© Copyright 1984-2012, American Hospital Association ("AHA"), Chicago, Illinois. Reproduced with permission. No portion of this publication may be copied without the express, written consent of AHA.

blefevre

Carmella,
Thank you for all the useful information. It is appreciated.
Barbara Lefevre

littlebit_62703@yahoo.com

Hello,
I found this discussion interesting and wanted to ask a question. I have a case where the patient has ESRD compliant with HD,  hypertension, ischemic cardiomyopathy with CHF came in for shortness of breathe and cough found to have mild pulmonary edema stat HD was ordered for the next day , hypertension uncontrolled,. no documentation of fluid overload chest xray shows edema and cardiac enlargement and no documentation of acuity level for pulmonary edema. Would you query on this for acuity and etiology based on this documentation and the coding clinic mentioned above? The facility I am auditing states that the etiology is already documented linking this to the ESRD since the MD states "stat Hemodialysis"  was ordered. Any help would be appreciated.

Thanks,