Chronicity of DVT/PE
I have been digging into mortality charts and have run across the
following scenario several times: the patient has either a DVT or PE or
both diagnosed prior to the current hospitalization but is still being
treated with anticoagulation (usually but not always warfarin). Usually
the PE/DVT is not coded in these cases. Sometimes the conditions are
documented as a "history of" DVT/PE even though they are being treated
during the hospitalization.
How do coding rules work for these diagnoses? Do we need to query for
the chronicity of the DVT/PE? When is a PE considered subacute or
choronic? When is a DVT chronic? Is the the 'history of" terminology
that is problematic here? Would it not also be correct to code the
long-term use of anticoagulants in these cases?
Cathy Seluke, RN, BSN, ACM, CCDS
Supervisor Clinical Documentation Compliance
MaineGeneral Medical Center
Augusta and Waterville, Maine
(207) 872-1796
Cathy.Seluke@mainegeneral.org
following scenario several times: the patient has either a DVT or PE or
both diagnosed prior to the current hospitalization but is still being
treated with anticoagulation (usually but not always warfarin). Usually
the PE/DVT is not coded in these cases. Sometimes the conditions are
documented as a "history of" DVT/PE even though they are being treated
during the hospitalization.
How do coding rules work for these diagnoses? Do we need to query for
the chronicity of the DVT/PE? When is a PE considered subacute or
choronic? When is a DVT chronic? Is the the 'history of" terminology
that is problematic here? Would it not also be correct to code the
long-term use of anticoagulants in these cases?
Cathy Seluke, RN, BSN, ACM, CCDS
Supervisor Clinical Documentation Compliance
MaineGeneral Medical Center
Augusta and Waterville, Maine
(207) 872-1796
Cathy.Seluke@mainegeneral.org
Comments
However, if current radiological studies and/or signs or symptoms indicate a DVT or PE is currently present, report with the code(s) for the chronic condition.
As your message indicated, a H/O may mean the condition was present in past, but has resolved, and pt may be on a drug to prevent recurrence. These are not coded as chronic thrombus.
OR, pt may currently have a 'chronic' DVT/PE, which would allow one to code as current condition...responding w/o access to any coding books or software.
For such cases, I query only if evidence of a chronic clot.
Paul Evans, RHIA, CCS, CCS-P, CCDS
If the PE/DVT was recent (I don't have a solid clinical reference, but would consider perhaps as much as 3 months) from initial dx...the PE may be considered as acute or sub-acute and under current tx. The coumadin does not 'remove' the clot, rather prevents formation of additional or expanding clots & there is a strong likelihood the clot is present. In this circumstance, we will query with the options including acute / subacute / chronic / history of.
Past that period, would likely query for chronic vs history of.
Don
Thanks,
Paul Evans, RHIA, CCS, CCS-P, CCDS
If a patient has a History of PE or DVT, I would code as a chronic DVT or PE IF the record documents a DVT or PE is currently present.
If the term H/O is used and it is not explicitly stated a PE or DVT is present, I would review clinical indicators and consider a query for clarification -resolved or chronic?
If this is truly an historical condition and record does not clearly document as a current clot, I would code with V-Codes.
It is a fairly common scenario and good food for thought.
AHA Coding Clinic
For those cases that the physician documents PE (not documenting status) & it has been less than 3 months, I would CONSIDER a query to ask the nature/status of the PE -- with the response options of acute, subacute, chronic, or history of.
Don