Calling all coders! Please help!

cmorell

Perhaps my coder misunderstood or misheard me? But here is the case:
MD writes "Anemia secondary to bleeding". My coder said we still need to clarify the acuity. Our physician advisor says no-bleeding means acute, now.

So, coders-do you code "Anemia secondary to bleeding" as Acute Blood Loss Anemia?

If so, please give me information to share with my coder.
If not, please give me information to share with my physician advisor.

My lead coder is out for the day and I need an answer asap.
Thanks!

kari.eskens

We have had this same discussion and have referred to this Coding Clinic. At our facility, we ensure that either the blood loss or the anemia is qualified as acute before we will use code 285.1.



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Kari L. Eskens, RHIA

BryanLGH Medical Center

Coding & Clinical Documentation Manager

NormaB

I would not code it as ABLA. I would have them specify the severity.

NBrunson, RHIA, CCDS

digardsk

I would clarify as the bleeding could be chronic.

susanklein

We request "acute blood loss anemia." The MD is supposed to write it out.

bea.smith

I agree, code because it could be a chronic blood loss anemia.

pfowler

Has to be clarified by the MD. Coders can't assume it is acute blood
loss anemia. As mentioned it could be chronic.



Patsy Fowler RN, MSN, CCDS

Certified Clinical Documentation Specialist

Marion Regional Hospital

PO Box 1150

Marion, SC 29571

Office 843-431-2044

Cell 843-431-2863

Fax 843-431-2432

janrumdavis

Agree with all the others, need to query for clarification. MD would have to specify either acute blood loss anemia, anemia due to acute blood loss, or acute anemia due to blood loss for our coders to code as ABLA. Sometimes upon querying MD will state it is due chronic blood loss.

lspryszak

Answer: according to ICD-9 CM (always the final authority), blood loss anemia NOS (not otherwise specified) codes to 280.0. The conditions included in 280.0 are as follows:
- secondary to chronic blood loss
- normocytic anemia due to blood loss.

Bottom line:

ONLY when the condition is documented as one of the following is it a CC:

- "Acute posthemorrhagic anemia (285.1) OR
- anemia due to acute blood loss (or another viable way
"acute blood loss anemia")

So - the coder is correct. We should always ask that the anemia be specified as either "acute" or "chronic" or possibly, if appropriate, "acute on chronic". When no specificity is provided, and if due to blood loss, the default is "chronic blood loss anemia".

angelamckee@uh.org

I'm not sure what you mean by the statement "Our physician advisor says no-bleeding means acute, now."  There is only one instance in which blood loss anemia is assumed to be acute. That is if your physician documents"postoperative blood loss anemia". Postoperative blood loss anemia is coded 285.1 which is acute posthemorrhagicanemia. The selection goes like this: 3M = select "anemia"; select "postoperative"; select "not documented as a complication";select "due to (acute) blood loss" = 285.1. For ICD-9-CM coding book = select main term "anemia"; select "postoperative"; select "due to (acute) blood loss 285.1. In both scenarios acute is within ( ) which indicates it isa nonessential modifier. Instructions for use of nonessential modifers are located in ICD-9-CM Official Conventions, which state: "Parenthesis enclose supplementary words, called nonessential modifers, that may be present in thenarrative description of a disease without affecting the code assignment. Some physicians prefer documenting postoperative blood loss anemia rather than acute blood loss anemia. As far as Iknow, all other acute anemias must be documented as such.  Thank you,

Angie Mckee, RHIT, CCDS, CCS, CCS-P
Clinical Documentation Specialist
Performance Improvement
University Health Care System
Augusta, Ga.  30901
706-774-7836  

lspryszak

From Coding clinic as well:

Postoperative Anemia

Coding Clinic, First Quarter 2007 Page: 19
Effective with Discharges: March 30, 2007

Question:

What is the correct code assignment for postoperative anemia? Coding Clinic Second Quarter 1992, pages 15-16, stated, “If the physician documents postoperative anemia in the medical record, but does not label the condition as a complication, assign code 285.1, Acute posthemorrhagic anemia.” Is this advice still valid?

Answer:

When postoperative anemia is documented without specification of acute blood loss, code 285.9, Anemia, unspecified, is the default. Code 285.1, Acute posthemorrhagic anemia, should be assigned, when postoperative anemia is due to acute blood loss. Revisions were made to the Alphabetic Index in 2004, which direct the coder in the following manner:

Anemia
postoperative
due to blood loss 285.1
other 285.9

The directives in the ICD-9-CM manual take precedence over advice published in Coding Clinic.


AND:

Postoperative Anemia Secondary to Expected Blood Loss
Coding Clinic, Third Quarter 2004 Page: 4
Effective with discharges: September 30, 2004

Question:

Our surgeons think that anemia due to an "expected" blood loss is integral to procedures. When we query the physician regarding patients whose lab values have dropped significantly after surgery to levels suggestive of anemia, the physicians are refusing to document anemia due to blood loss even if they monitor and transfuse the patient. They say the patients lost an expected amount of blood. I have read Coding Clinic, Second Quarter 1992, pages 15-16, and its discussion of postoperative anemia guidelines. But this issue doesn’t give us definitive information to give the physicians that clearly states, "blood loss anemia due to an expected blood loss can be documented and reported when the patient meets the clinical criteria of anemia and the diagnosis meets UHDDS guidelines for reporting other diagnoses."

Answer:

Coders should not use blood transfusions or abnormal lab findings as definitive variables in determining whether or not to code blood loss anemia without physician documentation. If in the physician’s clinical judgment, surgery results in an expected amount of blood loss and the physician does not describe the patient as having anemia or a complication of surgery, do not assign a code for the blood loss.

AND:

cmorell

Angela,
What my physician advisor meant was that bleeding means active bleeding and if it is active that means it is happening now and now means acute.
This is just an example of the challenges we face trying to teach physicians how to translate what they mean into terms that can be coded to reflect the true severity of illness/risk of mortality.

It is so helpful to have all of CDI talk available to respond. I hate to get put in a position where I feel I don't have enough ammunition to back up what I'm saying. Thanks to all of the timely responses, I was able to substantiate my point with more than just my own interpretation. My coder wasn't available at the time but everyone in ACDIS was!

cstukenberg

I have actually shown physicians the coding process with the software so they can see the choices the coders have to pick from. It is a good visual.

Colleen Stukenberg MSN, RN, CMSRN, CCDS
815-599-6820