Compensated- is that = to Chronic?
Our coders and CDI have a Monday morning coding conundrum so I turn to my CDI/coding experts!
Physician documented : "diastolic heart failure, compensated"
The coders are resistant to taking it to chronic.
Are you aware of any other reference that would support my hypothesis as stated in the Coding Clinic that "de-" =flare up... "-compensated"=chronic?
Thank you so much - Linnea
Linnea Thennes, RN, BS, CCDS, CCS
815. 759-8193
lthennes@centegra.com
________________________________
Question:
Coding Clinic, Third Quarter 2008, p. 12, states "decompensated indicates that there has been a flare-up (acute phase) of a chronic condition." Should this general definition of decompensated be applied when assigning ICD-10-CM codes as well? For example, what is the appropriate ICD-10-CM code assignment for a diagnosis of chronic systolic heart failure, currently decompensated?
Answer:
Assign code I50.23, Acute on chronic systolic heart failure, for decompensated systolic heart failure. As previously stated, "decompensated" indicates that there has been a flare-up (acute phase) of a chronic condition.
Question:
What is the correct code assignment for a diagnosis of "compensated respiratory acidosis" in a patient with chronic obstructive pulmonary disease (COPD)?
Answer:
Assign only code 496, Chronic airway obstruction, not elsewhere classified, for the COPD. It would be inappropriate to separately report a code for compensated respiratory acidosis.
Patients with chronic obstructive pulmonary disease (COPD) may experience difficulty in regulating blood gas levels. PaO2 may be low because oxygen is not effectively absorbed in the lungs. PaCO2 can be elevated because of inefficient exchange of carbon dioxide in the lungs. Because of the increase in CO2, the body's pH will decrease, resulting in respiratory acidosis. The kidneys can retain bicarbonate in order to compensate for the acidosis. This is referred to as "compensated respiratory acidosis," when the body's pH level is maintained within the normal range through compensatory mechanisms involving the kidneys or lungs.
Physician documented : "diastolic heart failure, compensated"
The coders are resistant to taking it to chronic.
Are you aware of any other reference that would support my hypothesis as stated in the Coding Clinic that "de-" =flare up... "-compensated"=chronic?
Thank you so much - Linnea
Linnea Thennes, RN, BS, CCDS, CCS
815. 759-8193
lthennes@centegra.com
________________________________
Question:
Coding Clinic, Third Quarter 2008, p. 12, states "decompensated indicates that there has been a flare-up (acute phase) of a chronic condition." Should this general definition of decompensated be applied when assigning ICD-10-CM codes as well? For example, what is the appropriate ICD-10-CM code assignment for a diagnosis of chronic systolic heart failure, currently decompensated?
Answer:
Assign code I50.23, Acute on chronic systolic heart failure, for decompensated systolic heart failure. As previously stated, "decompensated" indicates that there has been a flare-up (acute phase) of a chronic condition.
Question:
What is the correct code assignment for a diagnosis of "compensated respiratory acidosis" in a patient with chronic obstructive pulmonary disease (COPD)?
Answer:
Assign only code 496, Chronic airway obstruction, not elsewhere classified, for the COPD. It would be inappropriate to separately report a code for compensated respiratory acidosis.
Patients with chronic obstructive pulmonary disease (COPD) may experience difficulty in regulating blood gas levels. PaO2 may be low because oxygen is not effectively absorbed in the lungs. PaCO2 can be elevated because of inefficient exchange of carbon dioxide in the lungs. Because of the increase in CO2, the body's pH will decrease, resulting in respiratory acidosis. The kidneys can retain bicarbonate in order to compensate for the acidosis. This is referred to as "compensated respiratory acidosis," when the body's pH level is maintained within the normal range through compensatory mechanisms involving the kidneys or lungs.
Comments
Exacerbation of diastolic congestive heart failure
Coding Clinic, Third Quarter 2008 Page: 12 Effective with discharges: September 19, 2008
Question:
When a patient with a known history of CHF is admitted with an exacerbation of diastolic congestive heart failure, how would this be coded?
Answer:
Assign code 428.33, Diastolic heart failure, acute on chronic, and code 428.0, Congestive heart failure, unspecified. Dorland's Medical Dictionary defines "exacerbation" as an increase in the severity of disease or any of its symptoms. The terms "exacerbated," and "decompensated" indicate that there has been a flare-up (acute phase) of a chronic condition.
Katy Good, RN, BSN, CCDS, CCS
Clinical Documentation Program Coordinator
AHIMA Approved ICD-10CM/PCS Trainer
Flagstaff Medical Center
Kathryn.Good@nahealth.com
Cell: 928.814.9404
For $B!H(Bcompensated heart failure$B!I(B the body is $B!H(Bcompensating$B!I(B for the problems being caused by the heart failure (possibly acute heart failure). Compensation means the body is maintaining the homeostasis without the overt (noticeable) change in symptomatology (fluid on lungs or edema, HR increase, respiratory compromise, pulmonary hypertension, etc).
The free medical dictionary states compensated is this:
compensation /com*pen*sa*tion/ (kom$B!m(Bpen-sa$B!-(Bshun)
1. the counterbalancing of any defect.
2. the conscious or unconscious process by which a person attempts to make up for real or imagined physical or psychological deficiencies.
3. in cardiology, the maintenance of an adequate blood flow without distressing symptoms, accomplished by cardiac and circulatory adjustments.
________________________________
From: http://medical-dictionary.thefreedictionary.com/compensation
Hope this helps!
Mark
Mark N. Dominesey, MBA, RN, CCDS, CDIP, CHTS-CP
Director, Auditing & CDI Services
Office: 202.489.4662
Fax: 888.661.7790
Mark.Dominesey@TrustHCS.com
www.TrustHCS.com
Read our blog: http://www.trusthcs.com/blog/
As per previous message, 'exacerbation' of a chronic condition is coded as 'acute on chronic'.
"As previously stated, "Decompensated" indicates that there has been a flare-up (acute phase) of a chronic condition."
Example: Pt admitted for ORIF of femur and H&P notes 'history of systolic CHF" - MD notes staff must maintain typical meds for this condition and also 'watch I & O', restrict salt, weigh pt daily - Coder should assign code for CHRONIC SYSTOLIC CHF in keeping with advice cited by several in this message string. There is no need to query.
VOLUME 25 THIRD QUARTER
NUMBER 32 2008, Page 12
Chronic Diastolic Congestive Heart Failure
Question: When a patient has a known history of diastolic congestive (CHF), how would this be coded?
Answer: Assign code 428.32, Diastole, chronic, and code 428.0, Congestivee unspecified. This is coded as chronic due to the patient's known history.
Congestive , diastolic/systolic dysfunction, and acute and/or chronic terms have posed some concerns throughout the coding community. The Editorial Advisory Board (EAB) for Coding Clinic is currently reviewing these concerns. This subject is being addressed by the EAB and will be referred to the ICD-9-CM Coordination and Maintenance (C&M) Committee for possible code revisions.
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
Exacerbation of diastolic congestive heart failure
Coding Clinic, Third Quarter 2008 Page: 12 Effective with discharges: September 19, 2008
Question:
When a patient with a known history of CHF is admitted with an exacerbation of diastolic congestive heart failure, how would this be coded?
Answer:
Assign code 428.33, Diastolic heart failure, acute on chronic, and code 428.0, Congestive heart failure, unspecified. Dorland's Medical Dictionary defines "exacerbation" as an increase in the severity of disease or any of its symptoms. The terms "exacerbated," and "decompensated" indicate that there has been a flare-up (acute phase) of a chronic condition.
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
Linda
Linda Haynes, RHIT, CCDS | Manager, Clinical Documentation Improvement | Legacy Health
19300 SW 65th Ave. | Tualatin, Oregon 97062 | 503-692-8862 | lhaynes@lhs.org
Clinically though, compensated means that the body is maintaining homeostasis in non-obvious ways, but the person could still be experiencing something more than their chronic heart failure.
I understand and have not been querying for the meaning of “compensated heart failure”. But her coders may be using the clinical understanding shown above in resisting her.
Mark
There is sometimes a great deal of confusion in our fields regarding what is allowed and what is not allowed for reporting of ‘secondary’ conditions. In my view, this particular CC was very helpful. Sometimes coders can be ‘too conservative’ and this particular issue was put to bed a long time.
I am not sure why any coder would resist using this concept – with coders, I tend to use both clinical logic as well as precedence in CC, and the precedence is very clear. (The coders are remiss in this particular scenario – show them the CC, and if they don’t agree, take this to a higher level).
Best..PE
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
Heart failure - guideline Coding Clinic, Second Quarter 1990 Page: 16 to 18)
3. Compensated versus decompensated heart failure. These terms are sometimes used to further describe the ability or inability of the heart to handle the increased work load. The heart muscle commonly develops compensatory mechanisms on a chronic basis such as cardiac hypertrophy, ventricular dilatation, raised atrial pressures, or increased force of contraction. When these compensatory mechanisms become inadequate to maintain the increased work load, decompensation of the heart function results.