Pulmonary Hypertension

ssalinas

Below are cut-out from an actual hard cover coding book. (Yes, they do still exist though have to admit I do not pull it out often.)
This is from the hypertension table:
[cid:image002.png@01CF490C.2AD79380]


Only persistent pulmonary hypertension is under 'fetal'
[cid:image003.png@01CF490C.2AD79380]

Sharon Salinas, CCS
Barlow Respiratory Hospital
2000 Stadium Way, Los Angeles CA 90026
Tel: 213-250-4200 ext 3336
ssalinas@barlow2000.org

jschoonhoven

That's where I'd been looking. Page down another couple inches and pulmonary htn comes up again without being inset under fetal.

However, sounds like expert opinion is that regardless of indexing it is not an adult condition.

Janice Schoonhoven RN, MSN, CCDS
Clinical Documentation Integrity
Manager- PeaceHealth Oregon West Network

evanspx@sutterhealth.org

I have not seen this type of congenital condition documented in an adult.

The only caveat would be that 'if certain congenital conditions are not corrected and still exist, it is correct to code them' - this Is not the norm and one should take care the exact statement taken from the guidelines is applied properly.



. Chapter 14: Congenital Anomalies (740-759)
a. Codes in categories 740-759, Congenital Anomalies
Assign an appropriate code(s) from categories 740-759, Congenital Anomalies, when an anomaly is documented. A congenital anomaly may be the principal/first listed diagnosis on a record or a secondary diagnosis.
When a congenital anomaly does not have a unique code assignment, assign additional code(s) for any manifestations that may be present.
When the code assignment specifically identifies the congenital anomaly, manifestations that are an inherent component of the anomaly should not be coded separately. Additional codes should be assigned for manifestations that are not an inherent component.
Codes from Chapter 14 may be used throughout the life of the patient. If a congenital anomaly has been corrected, a personal history code should be used to identify the history of the anomaly. Although present at birth, a congenital anomaly may not be identified until later in life. Whenever the condition is diagnosed by the physician, it is appropriate to assign a code from codes 740-759.


Paul Evans, RHIA, CCS, CCS-P, CCDS

Manager, Regional Clinical Documentation & Coding Integrity
Sutter West Bay
633 Folsom St., 7th Floor, Office 7-044
San Francisco, CA 94107
Cell: 415.637.9002

evanspx@sutterhealth.org

jschoonhoven

Yes, but congenital was a nonessential modifier. Is this condition only referred to in a congenital sense clinically?

Janice Schoonhoven RN, MSN, CCDS
Clinical Documentation Integrity
Manager- PeaceHealth Oregon West Network

evanspx@sutterhealth.org

If an adult still has any congenital anomaly that has not been corrected , such as transposition of the great vessels, absent portion of anatomy, reversal of normal anatomy, the condition is reported for life.

This is how I am interpreting the guidelines. IF an MD were to state an adult has congenital PH, it is coded as a congenital condition as it has not been reversed. I would imagine this condition would cause severe heart failure, making the likelihood this code would be assigned in an adult very unlikely.

Personally, I have not seen this term used in the adult population and someone with greater knowledge of this condition would have to state if it is even possible that a patient would survive this condition into adulthood.

Paul Evans, RHIA, CCS, CCS-P, CCDS

Manager, Regional Clinical Documentation & Coding Integrity
Sutter West Bay
633 Folsom St., 7th Floor, Office 7-044
San Francisco, CA 94107
Cell: 415.637.9002

evanspx@sutterhealth.org

jlightfoot@marshallmedical.org

Additional information from Dr Gold was that pulmonary HTN exists and is
a normal part of oxygenation in utero, this pressure should drop once
the baby is born. If the pressure doesn't drop after birth, it is then
called "persistent pulmonary hypertension" and the newborn is at risk of
rapidly dying without medication to treat the condition. He also
specified that this is a congenital condition.



Based on that information, I'm assuming that the condition is either
corrected or the pt dies. Unsure if it can recur again as a result of
whatever congenital issue caused it in the first place? Sounds like
there are lots of thoughts on the topic. What a great discussion.



Maybe Dr Gold can speak to this on the blog??





Jillian Lightfoot RN

Clinical Documentation Team

Marshall Medical Center

Placerville, CA 95667

(530) 626-2770 Ext. 6203

jlightfoot@marshallmedical.org

evanspx@sutterhealth.org

AHA Coding Clinic