Post op complications
When a patient has a surgery such as Aortic Valve Replacement, and then within 24-48hrs post op he develops (1) aflutter (2) atelectasis......are these considered "post op complications" J95.89 for atelectasis and I97.89 for aflutter? Or does the physician have to specifically say the dx's are "related to the procedure" in order for them to be coded as complications. I am not talking about "misadventure" complications.
I find post procedure "complication" coding very confusing with regards to exactly how the physicians must state something in order for it to be a complication of a surgery.
Thank you in advance!
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I find post procedure "complication" coding very confusing with regards to exactly how the physicians must state something in order for it to be a complication of a surgery.
Thank you in advance!
DISCLAIMER: The information contained in this transmission may contain privileged and confidential information, including patient information protected by federal and state privacy laws. It is intended only for use by the intended recipient. If you are not the intended recipient, you are hereby notified that any review, dissemination, distribution, or duplication of this communication is strictly prohibited. The partaking of any action in reliance upon this information by persons or entities other than the intended recipient is illegal and a violation of the regulatory guidance in the Health Insurance Portability and Accountability Act (HIPAA). If you received this in error, please contact the sender immediately and delete the material from all computers.
Comments
did they exist prior to the surgery
were they related to the surgery or were they totally unrelated
do they meet UHDDS criteria as a valid diagnosis
Atelectasis as an x-ray finding after valve surgery is an x-ray finding. If something extraordinary has to be done, such as bronchoscopy, it's codable. If all that is done is incentive spirometry and early ambulation, everybody has that happen after valve surgery and it's not codable
Atrial arrhythmias have been studied after many major surgeries and the same three criteria as above should be answered. Take a look at this article on the web and you can listen to the explanation or read the explanation. Then you might develop a perspective that meets UHDDS guidelines:
http://www.heart-valve-surgery.com/heart-surgery-blog/2011/05/20/atrial-fibrillation-after-aortic-replacement/
Atrial fibrillation after open heart surgery in general and valve surgery in particular is a very common problem with an instance of anywhere between 20, 22 %, about 50%. And the etiology is not so clear to us and may go all the way from inflammation of the surgery to some more a basic mechanism related to heart function and possibly myocardial cell function that we published heavily about in the past.
So, when patients experience atrial fibrillation after surgery and the big question is how long it takes before they convert back to sinus rhythm. If it's anywhere between a couple of minutes to a few hours, then we usually don't treat it. However, if it's looks more sustainable and patients are symptomatic, we treat it with anticoagulant drugs and if it goes for over 18 hours, we start anti-coagulation (Coumadin). If anticoagulant drugs are not helping, then many patients do have to have electrical cardioversion. You can have anywhere between one to a few events and the good news now is that in 99% of the cases, it just goes away as the time passes. By six weeks this is minimal incidence.
I think this distinguishes which is incidental and which is a complication and meets criteria as a valid diagnosis.
Robert S. Gold, MD
CEO, DCBA, Inc
4611 Brierwood Place
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