Coagulopathy due to Coumadin
If the doctor documents Coagulopathy due to Coumadin, is it
appropriate to assign D68.32: Hemorrhagic disorder due to extrinsic
circulating anticoagulants? The patient has no bleeding problem at the
present time, but has PT of 117.7 with INR >10.
Coding Clinic 1Q2016 says that bleeding such as hemoptysis, hematuria, hematemesis, etc that is assoc with a drug as part of anticoagulation therapy is coded to D68.32, but our coder is not getting a flag directing her to assign the bleeding disorder, so thinks that a current bleeding problem is not necessary. I am thinking the correct code is D68.
What say you?
Coding Clinic 1Q2016 says that bleeding such as hemoptysis, hematuria, hematemesis, etc that is assoc with a drug as part of anticoagulation therapy is coded to D68.32, but our coder is not getting a flag directing her to assign the bleeding disorder, so thinks that a current bleeding problem is not necessary. I am thinking the correct code is D68.
What say you?
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Comments
Based on the information below, without any evidence of bleeding, you would only assign R79.1.
An increased risk of bleeding is an adverse effect associated with anticoagulation therapy. For bleeding in a patient who is being treated with warfarin (Coumadin), heparin, anticoagulants, or other antithrombotics as a part of anticoagulation therapy, assign code D68.32, Hemorrhagic disorder due to extrinsic circulating anticoagulants. To report the adverse effect of the properly administered anticoagulant, assign either code T45.515-, Adverse effect of anticoagulant, or code T45.525-, Adverse effect of antithrombotic drugs.
Heparin-induced thrombocytopenia (D75.82) is one of the most severe adverse effects of heparin therapy. Heparin therapy is widely used to prevent and treat clotting disorders. In some people, heparin triggers autoimmune conditions of severe platelet deficiency with severe thrombotic (clot-related) complications.
Hypercoagulable states refer to a group of acquired and inherited disorders caused by increased thrombin generation. There is an increased tendency for blood clotting, and there may be fibrin deposition in the small blood vessels. These disorders are divided into primary and secondary hypercoagulable states. Primary hypercoagulable states (D68.5-) are inherited disorders of specific anticoagulant factors. Secondary hypercoagulable states (D68.6-) are primarily acquired disorders that predispose to thrombosis through complex and multifactorial mechanisms involving blood flow abnormalities or defects in blood composition and of vessel walls. Examples of conditions that can cause secondary hypercoagulable states are malignancy, pregnancy, trauma, myeloproliferative disorders, and antiphospholipid antibody syndrome.
Prolonged prothrombin time or other abnormal coagulation profiles should not be coded as a coagulation defect. Code R79.1, Abnormal coagulation profile, is assigned for this abnormal laboratory finding. If the patient is receiving warfarin (Coumadin) therapy, however, a prolonged bleeding time is an expected result, and therefore code R79.1 is not assigned.