heart failure vs. CHF

kerryseekircherkerryseekircher
edited April 2016 in CDI Talk Archive
Has anyone read this article by Dr. Pinson from the June edition of ACP Hospitalist?
https://www.acphospitalist.org/archives/2014/06/coding.htm

It's a topic that has come up on the blog in the past. My question is, if the MD's follow what he is advising; there is no way to capture the same acuity/severity, because you would still end up with a code for CHF (which he is saying is not accurate). If I have misunderstood, please correct me! : )

Following the pathway in my grouper-heart failure-decompensated, systolic (or diastolic); I end up with one code for systolic heart failure and another for CHF.

Thoughts? Has anyone rephrased their queries to follow the ACC guidelines?

The article is a good read, but I am speaking to this paragraph from the article:

"In summary, heart failure should no longer be characterized as "congestive" or "CHF." Clinical classifications based on NYHA criteria, stage, and etiology rarely result in the correct codes to express the patient's actual condition and severity of illness. While these descriptions have great clinical utility and significance, for correct coding, the pathophysiologic classification of systolic and/or diastolic heart failure must also be specifically documented, as well as its acuity. Heart failure associated with a low EF is systolic, normal or elevated EF indicates diastolic failure, and the two can coexist in some patients".
Thanks,
Kerry

Kerry Seekircher, RN, BSN, CCDS, CDIP
Documentation Specialist Supervisor
Northern Westchester Hospital
400 East Main Street
Mount Kisco, NY 10549
Email: kseekircher@nwhc.net
Phone: 914-666-1243
Fax: 914-666-1013

Comments

  • jolene.filejolene.file
    edited April 2016
    Yes to code CHF correctly when specified as diastolic or systolic, you are required to used two codes.  The specific "acute "diastolic or systolic is sequenced as principal when it is the reason for admit .
     
    REF: C. Clinic , lst Qrtr. 2009. "When the diagnostic statement lists CHF along with either systolic or diastolic HF, two codes are required to report the specific type of heart failure: congestive, diastolic, and /or systolic."

    Jolene File,RHIT,CCS,CPC-H,CCDS
    Documentation Improvement Specialist-Coder
    Hays Medical Center
    jolene.file@haysmed.com

    IMPORTANT: This communication contains information from Hays Medical Center which may be confidential and privileged.  If it appears that the communication was addressed or sent to you in error, you may not use or copy this communication or any information contained therein, and you may not disclose this communication or the information contained therein to anyone else.  In such circumstances, please notify me immediately by reply email or by telephone.  Thank you.
  • kerryseekircherkerryseekircher
    edited April 2016
    I am aware of that- but the literature is saying not to document CHF at all. However, in the absence of CHF documentation, the grouper will still lead you to a second CHF code with the pathway I mentioned below.
    That's my concern-I tend to get a little stuck on details sometimes, but I try to anticipate targets, denials, etc.. and I just wonder if going forward there could be an issue with having a CHF code without documentation for it. Probably not, but just a thought.
    Thanks,
    Kerry
  • jolene.filejolene.file
    edited April 2016
    I agree, Norma, the coding professionals will follow approved guidelines assigning two codes when stated as congestive.   I think the issue is that the physician are no longer going to say "congestive" and that can cause problems.   Is that correct, Kerry?   Reference- C.Clinic, 4th Qrtr. 2004- Congestive heart failure is not an inherent component of systolic or diastolic heart failure.  I think in the instance when "congestive" is not documented you would code only the one code for systolic or diastolic HF .   That is my interpretation of the C.Clinic.

    Jolene File,RHIT,CCS,CPC-H,CCDS
    Documentation Improvement Specialist-Coder
    Hays Medical Center
    jolene.file@haysmed.com

    IMPORTANT: This communication contains information from Hays Medical Center which may be confidential and privileged.  If it appears that the communication was addressed or sent to you in error, you may not use or copy this communication or any information contained therein, and you may not disclose this communication or the information contained therein to anyone else.  In such circumstances, please notify me immediately by reply email or by telephone.  Thank you.
  • kerryseekircherkerryseekircher
    edited April 2016
    Hi Jolene-
    That's exactly what I meant: ) I played around with it some more in the grouper and I think I have a solution.
    If the MD documents Acute Systolic Heart Failure; only one code is assigned (42821) and it is still a MCC.
    If the MD documents Decompensated Systolic Heart Failure; two codes are assigned (42821 and 4280)-a MCC but with no documentation to support CHF.
    It seems to me that it would be best to have documentation consistent with 'acute systolic heart failure' if you want to play it safe/get the most accurate code.
    Thanks all!!
    Kerry
  • paxnerospaxneros
    "If the MD documents Acute Systolic Heart Failure; only one code is assigned (42821) and it is still a MCC.

    If the MD documents Decompensated Systolic Heart Failure; two codes are assigned (42821 and 4280)-a MCC but with no documentation to support CHF."

    Does not compute...?? :)

    Decompensation=Exacerbation=Acute...yes?

    Why would you add 428.0 on Decomp but not on Acute?

    Norma
  • elizabeth.hyndelizabeth.hynd
    edited April 2016
    It doesn't make sense but it ASHF is documented you code 428.21 and 428.0, and yes the 428.21 is an MCC :)

    Elizabeth Hynd RN, BSN, CCDS
    Clinical Documentation Specialist
    863/687-1100 x7313
  • kerryseekircherkerryseekircher
    edited April 2016
    Using the 3M grouper, using the pathway- failure-heart-other-systolic-acute-no other complications-I get one code 42821.
    Using the 3M grouper/pathway- failure-heart-decompensated-systolic-acute-no other complications-I get two codes.
    Relying on the grouper is not always accurate-so I'm probably missing something here. I'll talk it out with one of our Coder's who are much more knowledgeable than me in this area.

    Thank you to all who responded respectfully with their input.
  • catladyrncatladyrn
    "CHF" has been out of vogue for quite a long while. I have never included the term "congestive" in any heart failure queries I've written over the past six years, and the coding has been just fine. I can't imagine any auditor having a problem with a physician saying acute systolic heart failure with a code for congestive heart failure.

    Coding and clinical documentation don't always match up. Just as the current ACC guideline expects physicians to write, "HF with preserved EF" rather than diastolic; if they actually write that, we have to query to meet current coding standards.

    Renee

    Linda Renee Brown, RN, MA, CCDS, CCS, CDIP
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