query for direct link between CHF and diastolic and/or systolic dysfunction

I appreciate the information shared on CDI talk so I am reaching out to everyone for guidance on this subject.

After our coding department reviewed Heart failure and preserved or reduced ejection fraction Coding Clinic, First Quarter ICD-9 2014 Page: 6 Effective with discharges: March 31, 2014, coding decided to begin querying for a direct link between CHF and the systolic/diastolic dysfunction that is often times noted in the medical record, but not directly linked to the CHF diagnosis.

For example, CHF is documented in the H&P as the reason for admission. The attending consults cardiology and cardiology's progress note states severe systolic dysfunction. Coding is now directed to query for the type of CHF and not just acuity in this example. Also going forward, if documentation in the EHR states acute CHF on line 1 and systolic dysfunction is on line 4, coding will query for systolic CHF.

I want to share that the coding department submitted a question to AHA Coding Clinic about this concern, but AHA Coding Clinic is currently not accepting ICD-9 coding questions. The question was also submitted to 3M with a response that it is acceptable to code without a query.

Please offer your advice.
Thank you,
Julie

Julie Geiger, BS, RN, CCDS
Operational Lead Clinical Documentation Specialist
Parkview Health
Fort Wayne, Indiana
Phone: 260-266-1240
Email: julie.geiger@parkview.com

Comments

  • Coding Clinic allows one to code systolic, diastolic or combined type of CHF in example you provided.

    See References cited here:



    Question:
    The patient is documented as having systolic dysfunction with acute exacerbation of congestive heart failure (CHF). Can this be coded as acute systolic heart failure with congestive heart failure?

    Answer:
    Assign code 428.0, Congestive heart failure, unspecified and code 428.23, Systolic heart failure, Acute on chronic. Acute exacerbation of a chronic condition (heart failure) is coded as acute on chronic.

    ICD-9-CM’s Alphabetic Index provides the following direction for systolic dysfunction with heart failure:
    Dysfunction
    systolic 429.9
    with heart failure—see
    Failure, heart

    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:  415.412.9421

    evanspx@sutterhealth.org
  • edited April 2016
    We do not query for the link when the physician documents the diastolic and/or systolic dysfunction.
    Cindy

  • Agree with Cindy: There is no need to query when charts states the type of dysfunction concurrently with a diagnosis of CHF. This has been the case since the advice issued on this topic as below:




    AHA Coding Clinic® for ICD-9-CM, 1Q 2009, Volume 26, Number 1, Page 8


    (I am surprised your coding dept would not be up-to-date on this element of coding - do they have a subscription to C. Clinic)?


    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:  415.412.9421

    evanspx@sutterhealth.org

  • We won't query if CHF and then systolic dysfunction is written within the same few lines.
    But if CHF is written in a progress note and systolic dysfunction is written in the H&P we will Query for a link.


    Greta Goodman, CCDS
    Clinical Documentation Improvement Specialist
    Health Information Management
    Virginia Hospital Center
    1701 North George Mason Drive
    Arlington, VA 22205
    703-558-5336
    ggoodman@virginiahospitalcenter.com

  • If CHF is charted by a clinician in notes, H&P, consult, etc and 'systolic dysfunction' written in a similar fashion during the same episode of care, we do not query for linkage. IMO, clarification from C. Clinic states a query is not required and coders should code accordingly.



    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:  415.412.9421

    evanspx@sutterhealth.org

  • edited April 2016
    Attached is the Query we use.





    Thank you!

    Yuliya Fish, RN, BSN, CCDS, CDIP
    Clinical Documentation Specialist
    Mount Sinai Beth Israel Brooklyn
    Office 718-951-9976


  • Thank you for the thorough reference. I appreciate everyone's thoughts as I gather information and discuss it with coding.

    Julie
  • edited April 2016
    This is a multi-part message in MIME format.

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    I agree with Paul. If CHF is documented and then systolic and/or diastolic is validated within the same episode of care, we do not query for a link. I attached our query template that we use if not stated for anyone who would like to use.

    April Floyd, RN, CCDS
    Anderson RMC
    Meridian, MS
  • I agree with Paul, this is our practice as well.


    Jillian Lightfoot RN
    Clinical Documentation Team
    Marshall Medical Center
    Placerville, CA 95667
    (530) 626-2770 Ext. 6203
    jlightfoot@marshallmedical.org

  • Thank you all for sharing your practice on this topic. I appreciate the query template examples and Paul, your CHF reference is outstanding.

    Julie Geiger
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