Acute = Severe?

robert.hodges2robert.hodges2
in CDI Talk Archive
Is anyone aware of a coding clinic that says that a severe condition is the same as an acute condition. Example, "Severe CHF" being the same as "Acute CHF". My mind says they are different, but as always, I'm looking to the experts out there for an answer.

Thanks in advance.

Robert

Robert S. Hodges, BSN, MSN, RN
Clinical Documentation Improvement Specialist
Aleda E. Lutz VAMC
Saginaw MI 48602

(989)497-2500 x13101
Robert.Hodges2@va.gov

Comments

  • digardskdigardsk
    edited May 2016
    Interested to hear what the experts say, but I would think a chronic condition could be severe, and therefore the terms cannot be =.

    Kim

    Kim Digardi, RN
    Clinical Documentation Specialist
    St. Helena Hospital
    10 Woodland Road
    St. Helena, CA 94574

    Phone: 707.967.5936
    Email: digardsk@ah.org


  • Unknown
    edited May 2016
    I have not. I would query for acuity if appropriate.
    You can take exacerbation as acute CHF.

    Charlene


  • Unknown
    edited May 2016
    Is there a source that I can take to my coders stating that CHF exacerbation is "Acute CHF?" I've tried to discuss this with them but they state "exacerbation" is not enough.

    Thank you,
    Lisa


  • pbautistapbautista
    edited May 2016
    Here's the coding clinic you can give to your coders.
    VOLUME 25 THIRD QUARTER
    NUMBER 32 2008, Page 9



    Exacerbation of Diastolic Congestive Heart Failure



    Question: When a patient with a known history of CHF is admitted with an exacerbation of diastolic congestive heart failure, how would this be coded?



    Answer: Assign code 428.33, Diastolic heart failure, acute on chronic, and code 428.0, Congestive heart failure, unspecified. Dorland's Medical Dictionary defines "exacerbation" as an increase in the severity of disease or any of its symptoms. The terms "exacerbated," and "decompensated" indicate that there has been a flare-up (acute phase) of a chronic condition.





    Coding advice or code assignments contained in this issue effective with discharges September 19, 2008.

    Thank you,

    Pearley Bautista, RN, CCS
    Enterprise Medical Coding
    Ph: WW (310) 825-4777 SM (310) 319-4288
    Fax (310) 825-1174
    PBautista@mednet.ucla.edu


    IMPORTANT WARNING: This email (and any attachments) is only intended for the use of the person or entity to which it is addressed, and may contain information that is privileged and confidential. You, the recipient, are obligated to maintain it in a safe, secure and confidential manner. Unauthorized redisclosure or failure to maintain confidentiality may subject you to federal and state penalties. If you are not the intended recipient, please immediately notify us by return email, and delete this message from your computer.
  • digardskdigardsk
    edited May 2016
    Coding clinic 3Q08:

    "Assign code 428.33, Diastolic heart failure, acute on chronic, and
    code 428.0, Congestive heart failure, unspecified. Dorland’s Medical
    Dictionary defines "exacerbation" as an increase in the severity of
    disease or any of its symptoms. The terms "exacerbated," and
    "decompensated" indicate that there has been a flare-up (acute phase) of
    a chronic condition"

    Kim

    Kim Digardi, RN
    Clinical Documentation Specialist
    St. Helena Hospital
    10 Woodland Road
    St. Helena, CA 94574

    Phone: 707.967.5936
    Email: digardsk@ah.org


  • dogdog
    Lisa, first I would ask them how a non-acute exacerbation would present.

    Then I would show them this coding clinic and smile sweetly:

    Exacerbation of diastolic congestive heart failure
    Coding Clinic, Third Quarter 2008 Page: 12 Effective with discharges: September 19, 2008


    Question:

    When a patient with a known history of CHF is admitted with an exacerbation of diastolic congestive heart failure, how would this be coded?

    Answer:

    Assign code 428.33, Diastolic heart failure, acute on chronic, and code 428.0, Congestive heart failure, unspecified. Dorland's Medical Dictionary defines "exacerbation" as an increase in the severity of disease or any of its symptoms. The terms "exacerbated," and "decompensated" indicate that there has been a flare-up (acute phase) of a chronic condition.

    Renee

    Linda Renee Brown, RN, CCRN, CCDS
    Clinical Documentation Specialist
    Arizona Heart Hospital
  • dogdog
    Well, now I feel stupid. I didn't see the earlier answers to Lisa.

    As for the original question about severe vs acute, I could certainly see someone having severe CHF, up to and including end-stage heart failure, without being in an acute episode. No way would I take it as acute without a query.

    Renee

    Linda Renee Brown, RN, CCRN, CCDS
    Clinical Documentation Specialist
    Arizona Heart Hospital
  • Unknown
    edited May 2016
    You should not classify yourself as such. This job is an every day learning process. Today you have gained knowledge.

    Charlene



  • robert.hodges2robert.hodges2
    edited May 2016
    I've been told there is a coding clinic that says exacerbation = acute, but I don't have that reference.

    Robert

    Robert S. Hodges, BSN, MSN, RN
    Clinical Documentation Improvement Specialist
    Aleda E. Lutz VAMC
    Mail Code 136
    1500 Weiss Street
    Saginaw MI 48602
     
    P: 989-497-2500 x13101
    F: 989-321-4912
    E: Robert.Hodges2@va.gov
     
    "Anyone who has never made a mistake has never tried anything new." -Albert Einstein 


  • robert.hodges2robert.hodges2
    edited May 2016
    I agree with you Kim. "Severe" can very easily be chronic. That's why
    I'm posing the question since I don't think they are synonymous.

    Robert

    Robert S. Hodges, BSN, MSN, RN

    Clinical Documentation Improvement Specialist

    Aleda E. Lutz VAMC

    Mail Code 136

    1500 Weiss Street

    Saginaw MI 48602



    P: 989-497-2500 x13101

    F: 989-321-4912

    E: Robert.Hodges2@va.gov



    "Anyone who has never made a mistake has never tried anything new."
    -Albert Einstein




  • stacy.vaughnstacy.vaughn
    edited May 2016

    there is a coding Clinic 3Q 2002 that equals acute with exacerbation in
    the content of COPD. which is applicable to all scenarios.

    Stacy Vaughn, RHIT, CCS





  • stacy.vaughnstacy.vaughn
    edited May 2016
    I would not equate severe as acute.

    Stacy Vaughn, RHIT, CCS





  • dr_dexterdcosta@yahoo.comdr_dexterdcosta@yahoo.com
    edited May 2016
    Clinical perspective: In medical school, we were taught that terms like acute/acute on chronic/chronic indicate ONSET of Illness , while terms like Severe/Moderate/Mild indicate SEVERITY of illness!
    E.g. So when the MD documents severe renal failure , they are implying acute renal failure.(mcc)

    Coding perspective: The terms acute, acute on chronic, and chronic indicate severity of illness, but severe/moderate/mild do not reflect organ failure severity! (Classic example of disparity between coding and clinical world!!)

    Hence: I would query the physician to clarify that the worsening/severe organ failure documented reflects acute/acute on chronic organ failure! (even it sounds frustating to them that it's about Semantics!
    Dexter!


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