Graft versus host disease

byrd06byrd06
in CDI Talk Archive
Effective 2008 disorders involving the immune mechanism created a code for Graft Versus Host Disease which includes a code for Acute on Chronic GVH disease. The acute phase includes the period within the first 2 months of transplant. The chronic phase includes the period after 3 or more months of transplant. What would be an acute on chronic condition and should it be queried if not documented?

Example patient with complications rash and diarrhea and ascites on day 90 following liver transplant.

Comments

  • Unknown
    edited March 2016
    Not many facilities get into coding issues regarding transplants because not many facilities DO transplants. Congratulations for your bringing up a complex issue not understood by many folks who don't deal with this daily.

    The first thing is how long after transplant did the FIRST symptoms start. https://www.nlm.nih.gov/medlineplus/ency/article/001309.htm defines the situation. Your patient seems to have had first symptoms occurring at 90 days. They are symptoms of acute GVHD and fall within the parameters below of acute.

    The next thing is to determine if it is truly GVHD and not something else causing the patient's symptoms. Is there rejection or GVH? Is it both? Generally, biopsy of the skin can tell if it is acute GVHD. If it is rejection, that will be seen with liver biopsy.

    There are two types of GVHD: acute and chronic. Symptoms in both acute and chronic GVHD range from mild to severe.

    Acute GVHD usually happens within the first 6 months after a transplant. Common acute symptoms include:

    Abdominal pain or cramps, nausea, vomiting, and diarrhea
    Jaundice (yellow coloring of the skin or eyes) or other liver problems
    Skin rash, itching, redness on areas of the skin

    Chronic GVHD usually starts more than 3 months after a transplant, and can last a lifetime. Chronic symptoms may include:

    Dry eyes or vision changes
    Dry mouth, white patches inside the mouth, and sensitivity to spicy foods
    Fatigue, muscle weakness, and chronic pain
    Joint pain or stiffness
    Skin rash with raised, discolored areas, as well as skin tightening or thickening
    Shortness of breath
    Vaginal dryness
    Weight loss

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3129945/ this discusses a case sort of similar to yours.

    Check these out and discuss your patient with the transplant Gastroenterologists.

    Robert S. Gold, MD
    CEO, DCBA, Inc
    4611 Brierwood Place
    Atlanta, GA 30360
    (770) 216-9691 (Office)
    (404) 580-0204 (Cell)

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