I don’t know that a query is needed – especially if it was treated or monitored further. Sodium of 134 is below the generally accepted parameters. If it was treated, monitored, or if care (diet/fluid adjustment, additional labs, etc.) was in some way affected by this finding, I say code away! (I have attached a CC on borderline diagnoses.)
Coding Clinic, First Quarter 2012 Page: 17 Effective with discharges: April 1, 2012 Related Information Question:
Coders are confused as to the correct coding of “borderline” diagnosis. The advice published in Coding Clinic, First Quarter 2011, pages 9-10, appears to be contradictory. The advice instructs coders to assign code 416.8, Other chronic pulmonary heart diseases, for borderline pulmonary hypertension as if it were confirmed; however, a diagnosis of borderline diabetes without further confirmation of the disease is assigned to code 790.20, Abnormal glucose.
Should code 793.2, Nonspecific (Abnormal) findings on radiological and other examination of body structure, Other intrathoracic organ, be assigned for a diagnosis of "borderline pulmonary hypertension" or should all borderline diagnoses require clarification from the attending physician so that the appropriate code may be reported?
Answer:
"Borderline diagnoses" are coded as confirmed, unless the classification provides a specific entry (e.g., borderline diabetes). If a borderline condition has a specific index entry in ICD-9-CM, it should be coded as such. Since borderline conditions are not uncertain diagnoses, no distinction is made between the care setting (inpatient versus outpatient). Whenever the documentation is unclear regarding a borderline condition, coders are encouraged to query for clarification.
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
The normal range for blood sodium levels is 135 to 145 milliequivalents per liter (mEq/L). Normal value ranges may vary slightly among different laboratories. Some labs use different measurements or test different samples. Talk to your doctor about the meaning of your specific test results. I might query for significance of the the diagnosis made of a “mild” hyponatremia to see if the physician monitored and/or treated.
I don’t see a diagnosis of a mild hyponatremia the same as a borderline diagnosis like in diabetes or pulmonary hypertension. This is just one number away from the low normal lab value. Just my thoughts !
Sharon’s advice is right on. As she stated, if it was treated, monitored, etc., it would be appropriate to code it as it meets UHDDS criteria for assigning secondary diagnoses. Thanks, Donna Fisher, CCS, CCDS, CHC
I have just been denied for this exact situation – TWICE. They did not accept either my first level or second level appeal. In my situation the sodium was 132. I quoted our lab ranges, coding guidelines for secondary diagnoses, the treatment provided, etc. …
The insurance company’s response was that they “require†a sodium of less than 130 and that it be “clinically significant†(ie, showing symptoms???). They also stated that a sodium of 132 does not “typically require treatmentâ€â€¦therefore we should not have treated/coded it.
The fact that they all get to make their own rules is completely frustrating. Not only that, but they are completely ignoring coding guidelines.
I am welcome to any suggestions for my future cases, but all I can say is, Good Luck! ïŒ
Dana Walker, RN BSN Cone Health at Alamance Regional
I too have heard of denials for the same from a contract coder. Have been thinking of this as I read this thread. To be safe another facility I know of will not code hyponatremia unless there are two levels under 130 along with dx and rx.
This is an excellent discussion citing issues many of us when 3rd parties deny our claims.
Please recall there have also been excellent discussion on our site regarding the insistence of some 3rd parties that 'the condition must be stated in the summary in order for it to be coded'. The logic stated by some of the agencies or agents denying our coding is not reported to always be consistent w/ the Official Guidelines, and/or directives in AHA Coding Clinic. In my view, such practices are not compliant with HIPAA.
In addition, Robert's citation regarding the increased ROM associated w/ even mild hyponatremia is very compelling given 'coding' is not performed simply for reimbursement.
I am going to forward these issues to Brian and Melissa so that there may be consideration to have the ACDIS Board provide some feedback during a quarterly call.
KEY POINTS
1. Denials from 3rd Parties - appears official guidelines are not uniformly used by some agencies 2. Content of Summary - 3rd parties will deny a code for certain conditions if not restated in a summary
Paul
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
Clinical Documentation Improvement and Inpatient Coding Manager HIMS Department Good Samaritan Health System 4th & Walnut Sts Lebanon, PA 17042 dwilk@gshleb.org
Love it! Let's make it even better than a flat rate for the RACs. They should be put in the position that if they are found to be incorrect in their determination, they should pay the hospital bill! Or, if holding up payment pay the provider a high interest rate. Maybe they should have as much to lose as the providers.
Comments
Syndi Hudson, RN, CCDS,CCM
CHRISTUS Santa Rosa New Braunfels
CDI Specialist
cynthia.hudson@christushealth.org
830-643-6116 (Office)
830-643-5139 (Fax)
[CCDS_pin_1inch]
Of course, this is just my view….
[http://sv-3mxx-01:8080/reference2/images/blanknote.gif]
Borderline diagnoses - clarification
Coding Clinic, First Quarter 2012 Page: 17 Effective with discharges: April 1, 2012
Related Information
Question:
Coders are confused as to the correct coding of “borderline” diagnosis. The advice published in Coding Clinic, First Quarter 2011, pages 9-10, appears to be contradictory. The advice instructs coders to assign code 416.8, Other chronic pulmonary heart diseases, for borderline pulmonary hypertension as if it were confirmed; however, a diagnosis of borderline diabetes without further confirmation of the disease is assigned to code 790.20, Abnormal glucose.
Should code 793.2, Nonspecific (Abnormal) findings on radiological and other examination of body structure, Other intrathoracic organ, be assigned for a diagnosis of "borderline pulmonary hypertension" or should all borderline diagnoses require clarification from the attending physician so that the appropriate code may be reported?
Answer:
"Borderline diagnoses" are coded as confirmed, unless the classification provides a specific entry (e.g., borderline diabetes). If a borderline condition has a specific index entry in ICD-9-CM, it should be coded as such. Since borderline conditions are not uncertain diagnoses, no distinction is made between the care setting (inpatient versus outpatient). Whenever the documentation is unclear regarding a borderline condition, coders are encouraged to query for clarification.
© Copyright 1984-2015, American Hospital Association ("AHA"), Chicago, Illinois. Reproduced with permission. No portion of this publication may be copied without the express, written consent of AHA.
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
Normal value ranges may vary slightly among different laboratories. Some labs use different measurements or test different samples. Talk to your doctor about the meaning of your specific test results.
I might query for significance of the the diagnosis made of a “mild” hyponatremia to see if the physician monitored and/or treated.
I don’t see a diagnosis of a mild hyponatremia the same as a borderline diagnosis like in diabetes or pulmonary hypertension. This is just one number away from the low normal lab value. Just my thoughts !
Thanks,
Donna Fisher, CCS, CCDS, CHC
Claudine Hutchinson RN (CDI)
The insurance company’s response was that they “require†a sodium of less than 130 and that it be “clinically significant†(ie, showing symptoms???). They also stated that a sodium of 132 does not “typically require treatmentâ€â€¦therefore we should not have treated/coded it.
The fact that they all get to make their own rules is completely frustrating. Not only that, but they are completely ignoring coding guidelines.
I am welcome to any suggestions for my future cases, but all I can say is, Good Luck! ïŒ
Dana Walker, RN BSN
Cone Health at Alamance Regional
Please recall there have also been excellent discussion on our site regarding the insistence of some 3rd parties that 'the condition must be stated in the summary in order for it to be coded'. The logic stated by some of the agencies or agents denying our coding is not reported to always be consistent w/ the Official Guidelines, and/or directives in AHA Coding Clinic. In my view, such practices are not compliant with HIPAA.
In addition, Robert's citation regarding the increased ROM associated w/ even mild hyponatremia is very compelling given 'coding' is not performed simply for reimbursement.
I am going to forward these issues to Brian and Melissa so that there may be consideration to have the ACDIS Board provide some feedback during a quarterly call.
KEY POINTS
1. Denials from 3rd Parties - appears official guidelines are not uniformly used by some agencies
2. Content of Summary - 3rd parties will deny a code for certain conditions if not restated in a summary
Paul
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
Two other areas we are getting bite back from are acute pancreatitis and ATN. Just a heads up
Deanne Wilk, BSN, RN, CCDS, CCS
AHIMA approved ICD-10-CM/PCS Trainer
Clinical Documentation Improvement and Inpatient Coding Manager
HIMS Department
Good Samaritan Health System
4th & Walnut Sts
Lebanon, PA 17042
dwilk@gshleb.org
Phone: 717-270-7582
Cell: 717-580-1436
The problem with lack of accountability on the RACs part can be frustrating.
Fran~
Love it! Let's make it even better than a flat rate for the RACs. They should be put in the position that if they are found to be incorrect in their determination, they should pay the hospital bill! Or, if holding up payment pay the provider a high interest rate.
Maybe they should have as much to lose as the providers.