Exacerbation and Acute

robert.hodges2robert.hodges2
in CDI Talk Archive
A question for the group and all of your expertise.

If acute COPD is documented is there a coding clinic or other reference that says this is the same as an exacerbation of COPD?

Thanks all in advance!

Robert

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

Comments

  • stacy.vaughnstacy.vaughn
    edited May 2016

    Coding Clinic 3Q 2002
    Question:

    The patient comes into the hospital with "COPD in exacerbation." Can this
    be coded as "COPD with acute exacerbation" or does the physician have to
    state "acute?"

    Answer:

    Assign code 491.21, Obstructive chronic bronchitis, With acute
    exacerbation, for the following diagnoses: COPD in exacerbation, severe
    COPD in exacerbation, endstage COPD in exacerbation, and exacerbation of
    COPD.


    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




  • kari.eskenskari.eskens
    edited May 2016
    From Coding Clinic



    [cid:image001.png@01CB2FEA.D28C3D90]

    Kari L. Eskens, RHIA

    BryanLGH Medical Center

    Coding & Clinical Documentation Manager





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  • robert.hodges2robert.hodges2
    edited May 2016
    OK, but what if the provider documents acute and not exacerbation?



    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

    When Indexing COPD in the coding book, it has acute in parenthesis after
    exacerbation.

    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




  • kari.eskenskari.eskens
    edited May 2016
    Then let me quote this coding clinic:

    [cid:image002.png@01CB2FEB.8C9ED2B0]
    I interpret this to mean that acute and exacerbation are the same thing.

    Kari L. Eskens, RHIA
    BryanLGH Medical Center
    Coding & Clinical Documentation Manager


  • sbeattysbeatty
    COPD in exacerbation
  • robert.hodges2robert.hodges2
    Thanks all. It's causing confusing here with the coders. That's why I'm trying to figure this out so we all use the same terms and definitions. Maybe this is an opportunity for another coding clinic clarification?

    Robert

    Robert S. Hodges, BSN, MSN, RN
    Clinical Documentation Improvement Specialist
    Aleda E. Lutz VAMC
    Mail Code 136
    1500 Weiss Street
    Saginaw MI 48602
  • judithbatesjudithbates
    edited May 2016
    What about "decompensated". Does this mean the same as exacerbation? Nothing like splitting a hair in many ways!!!


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

  • fentona@bronsonhg.orgfentona@bronsonhg.org
    edited May 2016
    We code acute, decompensated and exacerbated as the same. We had many
    discussion about this with our CDS staff, management and inpatient
    coding. Our consulting firm 3M verified that all were to be coded the
    same. They did say acute alone meant new onset and codes as just acute.
    Decompensated and exacerbated describes acute on chronic and should be
    coded as such. 3M was just here on site in July.
    Hope this helps.
    Amy

    Amy Fenton, RN
    Clinical Documentation Specialist
    Clinical Operations Improvement
    Bronson Methodist Hospital
    601 John Street - Box 59
    Kalamazoo, MI 49007
    Office: (269) 341-8442
    Fax: (269) 341-8330
    Pager: (269) 513-3131
    E-Mail: fentona@bronsonhg.org

  • angelamckee@uh.organgelamckee@uh.org
    edited May 2016
    The prior information has been great. What you need to tell your coders regarding (acute) COPD exacerbation is that the word in parentheses is called a nonessential modifier. Nonessential modifiers are terms that may be present for a code, but do not have to be present to use the code. You can refer them to page vi of their coding book (If using Ingenix 2010 expert), for further information regarding this.
    Thank you,

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


  • robert.hodges2robert.hodges2
    edited May 2016
    I posed the question to the VHA HIM Coding Council and they gave an
    official response back which is the same that you and Amy gave me. I
    have forwarded that to the coders here so that we are all now on the
    same sheet of music.



    Thanks again everyone for your help and guidance J



    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




  • sbeattysbeatty
    edited May 2016
    Great advise, Angie. I so enjoy hearing from coding colleagues! It helps
    me understand the other side of the coin.



    Sandy Beatty, RN, BSN, C-CDI

    Columbus Regional Hospital

    2400 E. 17th Str.

    Columbus, IN 47201

    (O) 812-376-5652 (M) 812-552-6997



    "Great leaders are almost always great simplifiers, who can cut through
    argument, debate, and doubt to offer a solution everybody can
    understand."

    General Colin Powell


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