acute heart failure

msjonesmsjones
edited May 2016 in CDI Talk Archive
I have a question for anyone who can help w/ this scenario. A pt. w/ hx of diastolic heart failure, ch afib, and pulmonary htn was admitted with anasarca due to (R) heart failure per H&P. Pt presented w/ sob and swelling of abd and legs. Resp-20 and sats-98% on admission. The MD documented acute (R) sided chf, anasarca, ascites, severe pulmonary htn. I was told that this codes to acute cor pulmonale. The pt has no hx of chronic cor pulmonale. The hospitalist nor the cardiologist never mentions cor pulmonale. Is this the way you all would code this? Thanks for your help!


Michelle Jones, RN, BSN
Clinical Documentation Specialist
Vidant Roanoke Chowan Hospital
252-209-3012
msjones@vidanthealth.com

Comments

  • cynthia.a.goeweycynthia.a.goewey
    edited May 2016
    You can get to cor pulmonale if you use pulmonary hypertension as your pdx. The 3M coder than gives an option of R heart failure and then if enter acute it leads you to acute cor pulmonale. I do not know the coding guidelines though....if you can use the pulmonary hypertension as the pdx with the information that you have shared.
    Cindy
  • msjonesmsjones
    edited May 2016
    I think that's what our coder did. This pt 's presentation just didn't
    fit acute cor pulmonale based on a discussion w/ the hospitalist. I was
    just wondering what others thought or how they would address this.

    Michelle Jones, RN, BSN
    Clinical Documentation Specialist
    Vidant Roanoke Chowan Hospital
    252-209-3012
    msjones@vidanthealth.com
  • paxnerospaxneros
    edited May 2016
    So Cor pulmonale is not documented? Are you going to Query for this diagnosis?

    NBrunson,RHIA,CDIP,CCS,CCDS
  • katysuegood@gmail.comkatysuegood@gmail.com
    edited May 2016
    My understanding is that this would code to CHF.
    Failure-> heart->Right-sided->diastolic->acute gets you 428.31 and 428.0. We have this issue when we have ‘right-sided’ heart failure documented and end up with CHF fall-outs when in the MD’s opinion it is not actually CHF.
    Chronic Cor Pulmonale (as opposed to acute) is R sided HF caused by an underlying pulmonary process. It sounds to me like your patient does have chronic cor pulmonale. However, I am not sure how the coder got there with the current documentation?
    We would query for Cor pulmonale in this instance.

    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
  • msjonesmsjones
    edited May 2016
    Thank you all. That's what I had thought would be needed as well
    especially when I was told it would be coded that way when put in the
    encoder. I appreciate all the help

    Michelle Jones, RN, BSN
    Clinical Documentation Specialist
    Vidant Roanoke Chowan Hospital
    252-209-3012
    msjones@vidanthealth.com
  • msjonesmsjones
    edited May 2016
    This MD just happened to come on the floor and he said the pt did not
    have cor pulmonale (ch or acute). It was just strictly acute (R) sided
    heart failure.

    Michelle Jones, RN, BSN
    Clinical Documentation Specialist
    Vidant Roanoke Chowan Hospital
    252-209-3012
    msjones@vidanthealth.com
  • don.cdi.rn@gmail.comdon.cdi.rn@gmail.com
    edited May 2016
    Access to an encoder is an extremely helpful tool both for operations as
    well as learning.

    HOWEVER, every encoder does have these little pathways that can have
    you stepping on a landmine -- with unfortunate consequences. Please be
    careful out there ...

    One of the great things I appreciate about CDI Talk is how these types
    of questions get so much support and knowledge.

    (Hi Michelle!)

    Don
  • paxnerospaxneros
    edited May 2016
    I'm not "Picking" sides w/encoders but this is what you might call "Logic-based" vs. "Knowledge-based" issue. Some encoders will lead you down the "primrose path". And if you do not have the coding knowledge or experience it is very easy to get to inappropriate codes by answering questions and toggling boxes.

    NBrunson, RHIA,CDIP,CCS,CCDS
  • msjonesmsjones
    edited May 2016
    I agree Don. I too have a standalone encoder but I didn't actually put
    these diagnoses in on this one and was shocked when the coder told me
    this.

    Michelle Jones, RN, BSN
    Clinical Documentation Specialist
    Vidant Roanoke Chowan Hospital
    252-209-3012
    msjones@vidanthealth.com
  • katysuegood@gmail.comkatysuegood@gmail.com
    edited May 2016
    I’d be really curious to know what the MD thinks the underlying cause of the Right-sided failure is. If you have severe pulm HTN and right-sided failure I would think there is likely a connection there, especially if there is no evidence of L-sided failure (the most common cause of R-failure). I am not saying I would push the MD further and maybe I am wrong on this but in my experience where the issue is here is language. MD’s don’t typically use the term Chronic Cor Pulmonale to describe R-sided failure. When they think of Cor Pulmonale they are thinking of Acute cor pulmonale, which this is not.
    Am I the only one who has had this issue? We have ended up with CHF fallouts in these instances because it codes to CHF when the pt did not receive the required CHF treatment because treatment of R-sided failure is focused on the underlying cause and does not always match treatment for CHF.

    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
  • annnd2009@gmail.comannnd2009@gmail.com
    edited May 2016
    When you say fall out I assume you mean core measures. Makes me think of
    a question. What does your( and anyone else) facility use to monitor and
    collect data on core measures? Software? Enter straight into reporting
    tool I.e Premier? Excel spreadsheets? Other software? Does 3m or all
    scripts do anything with core measures?

    Thanks
    Ann
  • katysuegood@gmail.comkatysuegood@gmail.com
    edited May 2016
    Yes, I was referring to core measures. I am not intimately involved in this process but have only been brought in when our quality RN's have been frustrated by fall-outs. I believe they are using MIDAS to track core measures.
    As far as I know, 3m has nothing to do with core measures. However, core measures are impacted by Pdx (like CHF) so coding/sequencing can have a significant impact from what I have seen.

    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
  • annnd2009@gmail.comannnd2009@gmail.com
    edited May 2016
    Yes that's true. I did CdI in my old facility and Core measures now. We do a LOT of manual entry into a excel spread sheet and I have to believe there is a more efficient way. Just looking for what others do.

    If anyone thinks their Core Measure group may be open to inquiries by email, please pass this email to them. The process of the charts are reviewed are quite similar but some of the rules are strangely different.

    It has given me a new perspective on why doctors feel like strangling us at times. Everyone wants something a little differently from them with different rules as far as timeliness and acceptable source documents.

    Thanks,

    Ann

    annnd2009@gmail.com
  • wrightnawrightna
    edited May 2016
    We use online web-based software called Core Options at my facility.
    Easy to navigate.
  • jolene.filejolene.file
    edited May 2016
    In the 3M -CDIS product under the Early Warning tab,  Core Measure Info can be collected.  
     
    Jolene File,RHIT,CCS,CPC-H,CCDS
    Documentation Improvement Specialist-Coder
    Hays Medical Center
    jolene.file@haysmed.com

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