Question about coding Schatzki ring

nursronnamnursronnam
in CDI Talk Archive
I received this question from one of our coders and would love to here from the coders out there as to how they handle this diagnosis.

What does your organization state about coding Schatzki ring under the default of congential which is a MCC? I think we should come up with a hosptial policy on how this should be coded. I hope they take away its MCC status soon so it won't be a big of an issue. I feel really uncomfortable coding it as a MCC when it wasn't a factor at all the the patient care. I have had 2 recently where I had to question the decision to code it. What do you think about it? Thanks.

Ronna Mahlen, RN, BSN, C-CDS
Manager of Clinical Documentation
Overlake Hospital Medical Center
ronna.mahlen@overlakehospital.org

Comments

  • sbeattysbeatty
    edited May 2016
    If it wasn't a factor at all in the patient's care, is it a reportable
    condition? Should it be coded at all? Or is it an incidental finding?
    Perhaps I need more information....?

  • NormaBNormaB
    edited May 2016
    We code it. Usually it is found when we are looking for an etiology of GI Bleed. They can cause dysphagia and occasionally need dilition. But if they are not causing problems there really isn't a treatment for them.

    Our CDI consultants who trained us encouraged us to take them for MCCs and our outside auditor has not mention anything against taking them. And belive me, if she could she would! :)

    I am surprised they are still an MCC where ARF wil no longer be.

  • fishdl@shands.ufl.edufishdl@shands.ufl.edu
    edited May 2016
    Although the default code for unspecified Schatzki's Ring is the congenital code,
    1. Unless it meets the UHDDS criteria, I wouldn't code it.
    2. If it meets the UHDDS criteria, perhaps a query would be appropriate for clarification as to whether it is congenital or acquired.



  • susankleinsusanklein
    edited May 2016
    AHA coding guidelines specify that diagnoses are only coded when they
    are: evaluated, treated, complicate another condition, affect LOS,
    require increased nursing care, etc. If a diagnosis is present but does
    not affect patient's treatment in anyway, it should not be reported.
    Hope this helps.

  • lspryszaklspryszak
    The congenital version of Schatzki's ring (750.3) is a MCC and includes the following terms:
    Absent esophagus
    Atresia of esophagus
    Congenital:
    esophageal ring
    stenosis of esophagus
    stricture of esophagus
    Congenital fistula:
    esophagobronchial
    esophagotracheal
    Imperforate esophagus
    Webbed esophagus

    While the acquired version (530.3) is neither a CC or MCC and includes the following terms:
    Compression of esophagus
    Obstruction of esophagus
    Excludes: congenital stricture of esophagus (750.3)

    I think that if we're going to do the right thing all the time (and why wouldn't we?) we should query the physician as to the etiology of the condition.

    In the cases I've seen where this is documented, it usually ends up as either the reason for a bleed (found on EGD) or is the reason for dysphagia, so in those cases it's the PDx.

    I agree that if it's an incidental finding (we note it on the EGD report that was looking for something else) or it's in the history and not a focus of treatment, we shouldn't code it at all.
  • NormaBNormaB
    edited May 2016
    Our CDI Consultant trainer used the logic that the EGD is an evaluation of the ring. It may be found incidentally but it is evaluated at the time of procedure. If the ring is causing problems a dilation is usually done. Otherwise the treatment is to do nothing.

    As I mentioned, we've never had our outside reviewers take the code from us.



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