watershed

Can anyone provide some input on how you handle the cardiologist writing
"watershed effect" or "watershed event". My research has shown that
this can occur with afib, stroke and MI. One physician says it is a
subendo MI but another disagrees. I know it must be queried but wanted
to know if anyone had a good cardiology definition for this or if you
are seeing it.



Deanne Wilk, BSN, RN, CCS

AHIMA Approved ICD-10-CM/PCS Trainer

CDI Manager

Health Information Management Systems Department

Good Samaritan Health System

4th & Walnut Streets

Lebanon, PA 17042

717 270 4804




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Comments

  • Did they do a CT scan? I have never heard this terminology used with MI, only stroke (though I have not researched it). "Watershed"refers to the location in the brain where the ischemia is occurring.




    Cerebral infarction with hemorrhage

    Coding Clinic, Second Quarter 2013 Page: 10 Effective with discharges: July 8, 2013
    Question:
    The patient suffered a subacute ischemic right posterior parietal watershed infarct with small focus of subacute hemorrhage. How should this condition be coded?
    Answer:
    Assign codes 434.91, Occlusion of cerebral arteries, Cerebral artery occlusion, unspecified, with cerebral infarction, and 431, Intracerebral hemorrhage, for subacute ischemic right posterior parietal watershed infarct with small focus of subacute hemorrhage. In this instance, the patient had an ischemic stroke as well as hemorrhagic stroke. Both codes are required to fully describe the condition. As usual, newer advice supercedes that previously published in Coding Clinic. The current advice supercedes the advice published in Third Quarter 1997, page 11.


    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

  • edited April 2016
    Well the medical term for watershed means infarction itself. I guess my
    question is when they use this term we should be looking for either MI
    or stroke correct?



  • I thought it was specifically related to the cerebral artery. But like I said, I have not researched extensively....

    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

  • edited April 2016
    Not sure....I will definitely research more on this and share findings.
    Thank you



  • I am sorry - I got confused by the question at hand believing the presence of possible AMI was part of the equation - hence my response speaking to ACS versus AMI.

    (Anecdotally, I have only seen the term 'watershed' used in reference to CVA).



    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

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