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
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
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
Cindy
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
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
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
Thank you!
Yuliya Fish, RN, BSN, CCDS, CDIP
Clinical Documentation Specialist
Mount Sinai Beth Israel Brooklyn
Office 718-951-9976
Julie
------=_NextPart_e163318260ceeb106a8848a4fdbfa6de
MIME-Version: 1.0
Content-Type: text/plain; charset="utf-8"
Content-Transfer-Encoding: 8bit
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
Jillian Lightfoot RN
Clinical Documentation Team
Marshall Medical Center
Placerville, CA 95667
(530) 626-2770 Ext. 6203
jlightfoot@marshallmedical.org
Julie Geiger