Bipolar disorder and depression

julie.geigerjulie.geiger
in CDI Talk Archive
I would appreciate your thoughts on this scenerio: a 48 yo female is admitted for asthma exacerbation. Her PMH lists Bipolar disorder and further down in PMH depression is listed. Home medications of Zoloft and Trazodone were continued. During admission affect normal, judgement normal and mood normal. Physicans problem list includes depression. 296.50 bipolar disorder with current state depressed was coded on coding summary.

This scenerio has occurred a few times recently and the CDS choose bipolar unspecified stating that the patient was not in a current depressed state-no psych consult, mood and affect normal, appetite good.

Bipolar is a chronic illness and the patient can swing from manic episodes to depressive episodes at times. I feel when the patient is in a manic or depressive state and the physician documents it as such, then 296.50 is appropriate. Someone explained it to me that coding 296.50 is similiar to coding chronic diastolic heart failure if patient is continued on Lasix. I disagree and feel that a clarification to the physician for further specificity of the bipolar disorder is needed.

Apologies for the lengthy post and I thank everyone who can set me straight on this.

Julie Geiger BS, RN, CCDS
Operational Lead Clinical Documentation Specialist
Parkview Health
260-266-1240
julie.geiger@parkview.com

Comments

  • deanne_wilkdeanne_wilk
    edited May 2016
    I agree that it should be coded to unspecified and that Yes we should
    query it. The issue is that most times the attending does not know the
    background on the patient and when there is no Psych consult it can
    really be difficult. Depression is chronic with bipolar but so is
    mania. The other issue is that you can not say that just because a
    patient had a history of depression that it is related to her being
    bipolar because you do not know when that diagnosis was made for the
    patient. With that said, Yes, if there is further specificity, then for
    quality and clarification, we should Query. This does not happen,
    however, because results are not often fruitful when we do.

    Deanne Wilk, BSN, RN, CCS
    CDI Manager
    Good Samaritan Health System
    4th & Walnut Streets
    PO Box 1281
    Lebanon, PA 17042
    Desk: 717-270-4804
    Mobile work: 717-679-7926
  • debra.stewart@halifaxregional.comdebra.stewart@halifaxregional.com
    edited May 2016
    I agree that this should not have been coded as a current condition of bipolar w/depression, but should have been added as just history of patient, if it was not documented that patient was having a depressive episode then it should not have been coded as such! That is the way I see it...and if the coder was not sure it should have been queried to the physician. But it seems the documentation that you say that the patient was normal mood etc. clarifies right there that they were not having a depressive episode.

    Deb


    Debra Stewart, RN, BSN,
    Clinical Documentation Specialist
    Halifax Regional Health System
    2204 Wilborn Avenue
    South Boston, Va. 24592
    (W) 434-517-3317
    (C) 434-222-9884
    Debra.stewart@halifaxregional.com











  • julie.geigerjulie.geiger
    Thank you Deanne and Deb. I might present this at our Task Force meeting as education and discussion for CDS and Coding Specialists

    Julie
  • cynthia.hudson@christushealth.orgcynthia.hudson@christushealth.org
    edited May 2016
    We code this as a secondary diagnosis if it is being treated with current medication. It would be no different than hypertension that is controlled because patient is taking medication.

    Syndi Hudson, RN, CCM

    CDI Specialist

    Christus Santa Rosa New Braunfels

    600 North Union

    New Braunfels, Texas 78130

    cynthia.hudson@christushealth.org

    830-643-6116 (Office)

    830-643-5139 (Fax)



    "I press on toward the goal to win the prize for which God has called me." Philippians 3:14







  • ssalinasssalinas
    edited May 2016
    I would have coded bipolar with depression

    Would you have just coded the unspecified bipolar disorder? Or would you also have coded depression? The patient was being treated with meds for her depression. If she had not received them, then she may have exhibited signs of depression. Was there treatment for the manic phase? What history code would you use? My understanding is that once diagnosed with a bipolar disorder, you carry it for your lifetime. There is an excludes note for depression (311) that it is not to be used in conjunction with any code from the 296.xx series

    Sharon Salinas, CCS
    Health Information Management
    Barlow Respiratory Hospital
    2000 Stadium Way, Los Angeles CA 90026
    Tel: 213-250-4200 ext 3336
    FAX: 213-202-6490
    ssalinas@barlow2000.org


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