RE: CHF Query

pfowlerpfowler
edited May 2016 in CDI Talk Archive
IF the physician documents on admission dx CHF Exacerbation. Do you
still query for type, ie. Systolic, diastolic,etc.?



Patsy Fowler RN, MSN, CCDS

Certified Clinical Documentation Specialist

Marion Regional Medical Center

PO Box 1150

Marion, SC 29571

Office 843-431-2044

Cell 843-431-2863

Fax 843-431-2475






Comments

  • fostermafosterma
    edited May 2016
    Yes, you should pursue all the specifics of the heart failure that is known or pertinent. More than one code can often be used to capture the specifics which address the risk of mortality and severity of illness data for the diagnosis.
    Roberta Fosterman RN
    Clinical Documentation Specialist
    Mail Code OP17A
    Phone 503-418-4024
    Fax 503-494-8439
    fosterma@ohsu.edu




  • robert.hodges2robert.hodges2
    edited May 2016
    Always! But, if they have ordered an Echocardiogram, I normally wait
    until the results are back to give them the chance to review the results
    and update their documentation.



    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




  • cbarnescbarnes
    edited May 2016
    We have a big push @ our facility to get the type for specificity.


  • kmaritankmaritan
    edited May 2016
    CHF exacerbation codes to 428.0 CHF, unspecified. To capture the acute on chronic (exacerbation) you need to always get the specificity of type, systolic or diastolic or both systolic and diastolic. The acute on chronic would increase severity and is an MCC. If a physician writes just "combined", our coders here request a clarification to have "both systolic and diastolic" documented.


  • dallend@einstein.edudallend@einstein.edu
    edited May 2016

    We do query for type of CHF - we will look for an ECHO, etc. If the patient has a normal ECHO we do not query for type of CHF.


  • robert.hodges2robert.hodges2
    edited May 2016
    I disagree with your statement about not querying with a normal echo only because the provider may be able to specify the type based on the clinical presentation of the patient. In my opinion it’s always worth asking if for no other reason than to get the providers used to specifying the type in their documentation.



    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




  • sharon.truittsharon.truitt
    edited May 2016
    I would be very careful with your query in this scenario if there are no
    other clinical indicators that would trigger it. It could be considered
    a leading query.



    Sharon Truitt, LPN, CCS

    BayCare Health System HIM Coding Supervisor


  • dbutlerdbutler
    edited May 2016
    How can it possibly be a leading query?
    If one pays attention to being certain to appropriately ask only chronic (when there are no tx indicators for acute), and provides as options the handful of clinically reasonable options (based on the ICD9 codes) for the specificity of CHF (along with 'don't know')? -- systolic, diastolic, combined, left, etc.

    If worded reasonably well yet such a query is considered leading, then it is impossible to ask any question without being leading!! IMHO that is.....

    Don


  • robert.hodges2robert.hodges2
    edited May 2016
    If the provider has already documented a CHF exacerbation, it shouldn't
    be leading if you are simply asking if they are able to clarify the type
    (systolic vs. diastolic) based on the clinical presentation of the
    patient even if the echocardiogram is normal.



    I have had cases where CHF was documented by the admitting physician and
    the echo came back normal. I then query for clinical significance, if
    any, of the echocardiogram results. It's the providers call and
    sometimes I do get the heart failure specified and sometimes I don't and
    sometimes I get a note indicating that the patient doesn't have heart
    failure. In any event, it's always worth asking.



    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




  • angelamckee@uh.organgelamckee@uh.org
    edited May 2016
    I also disagree with the statement of not quering with a normal echo. As Robert suggested, the physician may be able to specify the type according to the cilnicalpresentation of the patient. According to the CCDS exam study guide "It is estimated that 20%-50% of patients with heart failure have preserved systolicfunction or a normal left ventricular ejection fraction  (EF)".   
    Thank you,

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


  • sharon.truittsharon.truitt
    edited May 2016
    I agree, understand and appreciate your views; however my position is
    that with a normal echo; if the physician documents Diastolic/Systolic
    CHF based on the Query; a Medicare auditor or RAC, could very possibly
    state that the clinical diagnostics do not support the physician
    documentation and without a good clinical picture i.e RX, SX,increase
    LOS etc. to support the query; the appeal could be lost.

    Sharon Truitt, LPN, CCS
    BayCare Health System HIM Coding Supervisor


  • judithbatesjudithbates
    edited May 2016
    In my practice, If the physician is documenting CHF and treating CHF, I will query for specificity.

    Judi Bates RN, BSN, CCDS
    CDI Specialist
    856-757-3161
    Beeper 66x2906

  • dbutlerdbutler
    edited May 2016
    In that case, wouldn't asking the physician to include the clinical data that points toward the specific diagnosis be quite helpful?
    I know, in an ideal world.......

    Don


  • dallend@einstein.edudallend@einstein.edu
    edited May 2016

    At the time we discussed this with our Chief of Medicine - he felt and we agreed that if an ECHO is normal we would not query for any further specificity. Our physicians use the ECHO as the determining factor when it comes to left sided heart failure.

  • dbutlerdbutler
    edited May 2016
    Having that consensus and understanding offered by the medical staff is good support!!

    Don


  • robert.hodges2robert.hodges2
    I'm with you Don. The provider would have to support his clinical decision and be able to support that in the event of an appeal. In my mind, it's always worth asking the question, even if the answer is "I don't know".

    Robert

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