ABLA

judithbatesjudithbates
in CDI Talk Archive
I had read a criteria for ABLA of a sudden drop in hematocrit of 20%. Is anyone familiar with this and its origin??? I am trying to add this to our ANEMIA Query for clarity of ABLA.
THANKS!

Comments

  • dogdog
    I've never heard that. Certainly if someone showed a large sudden drop in Hct I'd be looking to see why, but I don't think it can automatically be attributed to ABLA. Hemodilution could be one alternative explanation. If someone goes from an Hct of 45 to 36 (a 20% loss), is it even anemia? :)

    I look for a potential clinical explanation of the drop in H/H (such as EBL in surgery) along with a treatment before I query ABLA.

    Renee

    Linda Renee Brown, RN, CCRN, CCDS
    Clinical Documentation Specialist
    Arizona Heart Hospital
  • paula.sonnpaula.sonn
    edited May 2016
    That would apply more for a precipitous drop in hct rather than anemia.


  • sbeattysbeatty
    edited May 2016
    Well said, Renee. The entire clinical picture must be considered. What
    was the PMH and pre-op Hgb? Do they have a history of renal disease or
    auto immune disorder that would cause a low Hgb as a baseline?

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  • judithbatesjudithbates
    My thought is that cardiac surgeons are reluctant to doc "expected acute post-op anemia". I thought if I could give them criteria they would have more buy-in. Any thoughts??? I appreciate the input...
  • sbeattysbeatty
    edited May 2016
    See if your organization is participating in the Society for Thoracic
    Surgeons (STS) database. What they call complications is different than
    how things code. We've had that issue with encephalopathy.

    Is there anything else I can do for you?
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    meet your needs. Please complete a satisfaction survey for our
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    Sandy Beatty, RN, BSN, C-CDI
    Clinical Documentation Specialist
    Columbus Regional Hospital
    Columbus, IN
    (812) 376-5652
    sbeatty@crh.org

    "Obstacles are those frightful things you see when you take your eyes
    off the goal." Hannah More

  • arobinsoarobinso
    edited May 2016
    I explain to my CT surgeons and Vascular surgeons, that this will not show up as complication,(as it is expected) that is their main worry. It has also helped telling them about SOI & ROM.

    Mandi Robinson, BS, RN, CPC
    Clinical Documentation Specialist
    Trover Health System
    270-326-4982
    arobinso@trover.org
    "Excellent Care, Every Time"



  • angelamckee@uh.organgelamckee@uh.org
    edited May 2016
    Drop in hematocrit (precipitous) is a coding option. I believe it was within the lastfew years that a code was developed for this. All the physician needs to document is the actual verbage drop in hematocrit. Code is 790.01. This is a CC, so it seems to be a resonable alternative (when lab values confirm) and  physicians are reluctant to document acute blood loss anemia.   
    Thank you,

    Angie Mckee, RHIT, CCDS, CCS, CCS-P
    Clinical Documentation Specialist
    Performance Improvement
    University Health Care System
    Augusta, Ga.  30901
    706-774-7836  



  • dsmith12h@aol.comdsmith12h@aol.com
    edited May 2016
    I agree with drop in hct.-- however, our lead coder tells us that they don''t code "drop in hct." because they consiser it to be just and abnormal lab finding. We have Discussed this many times with them and they haven't agreed with us yet.





  • stacy.vaughnstacy.vaughn
    edited May 2016

    the code 790.01 has "Precipitous" drop in hemo. Coding would need the dr
    to say that as you can't assume and nobody but the physician can make that
    determination. Correct?!?

    Stacy Vaughn, RHIT, CCS
    Data Support Specialist/DRG Assurance
    Aurora Baycare Medical Center
    2845 Greenbrier Rd
    Green Bay, WI 54311
    Phone: (920) 288-8655
    Fax: (920) 288-3052




  • dogdog
    Judith, I think you still have to ask them for blood loss anemia, even if they say it's acute postoperative. But, at least according to HealthGrades, ABLA is not a complication unless the physician documents it as a complication. I have been known to state that right on the query form if I think I'm going to have a reluctant doc.

    If there is a code for precipitous drop in Hct, why would the coders refuse to code it when the physician states it? I can see them refusing to code it based only on the lab values, but if the physician includes it as a diagnosis in their notes, I don't know how they can refuse to accept it. (Shame-faced disclaimer: I wasn't even really aware of this code and have never tried to get a physician to write it. I always go for the ABLA when clinically warranted.)

    Renee

    Linda Renee Brown, RN, CCRN, CCDS
    Clinical Documentation Specialist
    Arizona Heart Hospital
  • angelamckee@uh.organgelamckee@uh.org
    edited May 2016
    If you look at the coding book or 3M, the word (precipitous) is listed in just that way. Words in parenthesis are nonessential modifiers. Nonessential modifiers are words that may or may not be present in order to use the code. In other words,they don't have to be present to use the code. You can find definition in coding rules (instructions for use of coding book) located at the beginning of coding books.  
    Thank you,

    Angie Mckee, RHIT, CCDS, CCS, CCS-P
    Clinical Documentation Specialist
    Performance Improvement
    University Health Care System
    Augusta, Ga.  30901
    706-774-7836  


  • dsmith12h@aol.comdsmith12h@aol.com
    edited May 2016
    I agree, there is a code and if the doctor documents it, I feel it should be coded but again--coding disagrees. They have also refused to document the patients BMI (61) when the Dr. has documented it with a diagnosis of morbid obesity. Documentation suporrted the diagnosis (ie. Ht, Wt, Dietary consult to calculate BMI due to AKA, OSA with obesity hyperventilation syndrome). Things we have to work through.






  • judithbatesjudithbates
    This has been all great input. I know the question of ABLA comes up frequently on CDI talk...
    If anyone does come across any defining criteria maybe you can just post that. I do tell the docs that it is not counted as a complication but they just seem to think it is part of the patient's physical status as a post-op CABG and does not need to be specifically documented.
    I have also talked about SOI/ ROM to no avail...Our program is almost 2 years old and everytime I approach them directly, it's like the first time they ever heard it!!!
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