ABLA
Looking for feedback on when to code ABLA with the following documentation:
- "Acute blood loss anemia secondary to surgery not requiring transfusion. Expected acute blood loss" - code or not
code
-"Anemia associated with acute blood loss" -- no transfusion given -- code or not code
-"Anemia associated with acute blood loss" -- transfusion given -- we code this
-"Asymptomatic acute postoperative blood loss anemia" -- no transfusion given -- code or not code
-"Asymptomatic acute postoperative blood loss anemia -- transfusion given -- code or not code
- "Acute blood loss anemia secondary to surgery not requiring transfusion. Expected acute blood loss" - code or not
code
-"Anemia associated with acute blood loss" -- no transfusion given -- code or not code
-"Anemia associated with acute blood loss" -- transfusion given -- we code this
-"Asymptomatic acute postoperative blood loss anemia" -- no transfusion given -- code or not code
-"Asymptomatic acute postoperative blood loss anemia -- transfusion given -- code or not code
Comments
I would code all of the above as ABLA. Anemia was evaluated, monitored &/or treated. The Provider chose to classify it as acute - that's their prerogative.
Jeanne McCorkle BSN, RN, CCDS
-"Anemia associated with acute blood loss" -- no transfusion given -- code or not code
-"Anemia associated with acute blood loss" -- transfusion given -- we code this
-"Asymptomatic acute postoperative blood loss anemia" -- no transfusion given -- code or not code; this is tricky - - - If it is being monitored with daily CBCs, code; if not, you need to ask the doctor if it has any significance, if the response is NO - - - DO NOT CODE. The issue here is, is the ABLA considered incidental finding or not? The fact that they added asymptomatic made it tricky, especially in the postop condition. Auditors might argue, it is really dilutional. Also how much blood was lost, what kind of surgery was done etc. I look at it the way the coding clinic want post-op atelectasis handled, do not code if it has no significance or asymptomatic, code it if you are treating/monitoring it or meets any of the other criterial for reporting secondary diagnoses. In the end, when in doubt QUERY! QUERY!! and QUERY some more!
-"Asymptomatic acute postoperative blood loss anemia -- transfusion given -- code or not code; why give transfusion, it is truly asymptomatic . . . blood is not a benign treatment, especially allogenic transfusion. That being said, playing along with this hypothetical situation, code it. The auditors are not too intelligent, they look for transfusion in all cases of ABLA. So they would not deny an "asymptomatic" ABLA where blood was given.
Briefly, we "look for"
1. True Anemia for that patient
2. Documented loss of significant amount of blood - at least 300 cc
3. Reportable per UHDDS Definition?
4. If surgery, cite H/H prior to and after surgery
5. Loss of 'about' 20% H/H
Acknowledge some of the 'numbers' are arbitrary, but as a team, we researched and agreed to the above. Can't find a definitive or authoritative definition for ABLA in literature? Does anyone have it?
Paul
Why mention 300 cc of blood and 20% H/H in the same context? If the average person has 5L of blood, 300 cc = 6% . . . and that is significant? But then you expect the H/H to go down by 20%?
Please explain this mathematics to me. Thank you.
Dear Kbalogun. Are you going to continue to hide your identity and post anonymously, as I imagine you shall.
I did say we researched this, but could not we could find precise definitions with cited amounts of loss of blood so as to constitute what might be regarded as 'significant". I did not say we performed research. Our team is comprised of my self and 5 RNs, and we all provided input. So, no, this is not a discussion undertaken only amongst those you erroneously consider ignorant.
I have actually seen many clinicians, RNs, MD, etc, working for consulting firms that advocate a query for ABLA, and no citation of the amount of blood is referenced, and I've seen many advocate a query for ABLA when the loss of blood is less than 300cc. My approach is to try to establish at least a minimal amount of blood that one may see in order to consider this a viable query.
Our team does feel this condition can be over-reported; so, we did have conversations with physicians, and despite your rant, many of them stated that loss of at least 300cc should be considered in the equation for ABLA. Do you care to offer precise input as to what YOUR research has revealed? What precisely is the exact minimum amount of blood loss one should cite in a query in order to provide clinical context and support. Precisely how do we discount for the effects of dilution? Exactly 'how much' blood, Kblagoun, since you are a clinical expert, causes ABLA?
Paul Evans
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Director, ACDIS
Jeanne
Briefly, my point and solicitation for advice revolves around:
1. Does anyone else consider the amount of stated blood loss one should see in context of this situation? I did not state that only 300cc is always causing symptoms, or something ridiculous such as shock. Rather, I HAVE seen some CDI issue a query for ABLA in which the amount of blood is not referenced, and think that is an oversight. I have also seen a query issued for ABLA when the amount of blood lost is much less than 300cc, and think that is problematic. When one issues a query for ABLA, we should cite the amount of blood loss that is documented, if feasible, for clinical context. So, 300cc is our minimal threshold for query consideration. Totally different that response provided by "Kablogun", and he/she totally misrepresented what I had stated.
2. In this context, how does anyone allow for the effect of dilution?
3. Yes, we have had conversations with our Medial staff, and whilst 300cc does not necessarily cause alarm, we are told this is the threshold for concern. (I was trained to look for at least 500cc, but our team adopted 300cc as a team decision).
4. Yes, a decline of 20% does not correspond to loss of 300cc, did not say it should or must. Rather, stated we don't even begin to think of ABLA unless we see loss of 300cc as a minimum - this may not account for bleeding prior to admission or after any procedure into dressings. 20% is probably not the correct reference, as we do know ABLA is present w/ lesser amounts. However, we are operating out an abundance of caution in today's environment.
5. Yes, one can find definitions for ABLA in literature, but I've not seen an amount of blood loss referenced, rather what one finds referenced is the abrupt decline in Hematocrit that the author states constitutes ABLA.
Thanks, Paul Evans, RHIA, CCDS, CCS, CCS-P
Paul,
I haven't found concrete info on criteria for ABLA...usually in adults you see a decent drop in H/H with 350-500cc. We usually query around this blood loss unless it appears dilution & we monitor for a few days to see how it shakes out. I'd love to hear if other facilities have a minimum threshold to consider when querying for ABLA and if anyone has found any good references.
Jeff
Thank you, Jeff. Good to hear that your team also begins to consider this scenario in cases w/ similar amount of blood loss.
Paul
1. Does this lend any other discussion to the topic?
2. Also, am I ascertaining that a transfusion is not needed to code ABLA, if it was evaluated, monitored and/or treated?
I work in pediatrics, so we do not have a specific EBL threshold. We generally use best guestimates based on mL/kg of blood volume lost, but our organization has not defined a mL/kg threshold.
Jackie Touch
Physician Query Handbook (ACDIS/HCPRO)
pg 53
"Acute blood loss anemia is anemia due to major blood loss. Most physicians consider major blood loss as 20% of one's red cell mass, thus a fall in the HCT of over 8 points from baseline would qualify"