congenital heart diseases
I know I have asked something similar to this, but I am trying to put together a really strong educational document of when to code and when not to code congenital heart diseases to discuss with our coding team, because the coding team and I differing views on many of these...Would love any input that you have (and references if you have them 
)...
- when do you code HLHS/HRHS/Tricuspid atresia/aortic coarction/hypoplastic aortic arch (i.e patient is post Fontan do you still code the HLHS- why/whynot?
- Which of these is fixed with surgery, which do you consider a lifelong issue (i.e would code for the lifetime of the patient
.....also, may use some of this info in my CHD presentation at national conference.
thanks for the help and feel free to email me if that is easier
Leah Savage, MSN, RN, CCDS
Norton Children's
leah.savage@nortonheatlhcare.org
Comments
Hi Leah, you said
"when do you code HLHS/HRHS/Tricuspid atresia/aortic coarction/hypoplastic aortic arch (i.e patient is post Fontan do you still code the HLHS- why/whynot?
We code these until they have had their final surgery, then we code them as history of. In may cases there are several time these kids need surgery and they may not be repaired until later in life.
I do remember reading something in the coding guideline Ch 17 about congenital malformations
'Which of these is fixed with surgery, which do you consider a lifelong issue (i.e would code for the lifetime of the patient"Steph
Hi,
We have a pediatric cardiac ICU. I was a nurse on the unit for 8 years before I became a CDI specialist. My understanding is that the only "cure" to a HLHS would be a heart transplant. We continue to code the HLHS through the Fontan procedure, until (or if) the patient receives a heart transplant. The Norwood, Glenn, and Fontan are all what we call palliative surgeries. I would love to hear how other facilities code this.
Merissa
This is 'very' advanced, and I am replying w/o 'researching' Coding Clinic. As I recall, there is a Coding Clinic speaking to the issue of Congenital Heart Disease that is 's/p' repair. Basically, it states we are to code any 'defects' that remain after any repair given that these are corrected with multiple procedures. In my experience, we admit these patients after the repair, and perform heart catheterizations. These studies will document the precise nature of any remaining residuals, which are then coded. I may later find time to research the Coding Clinic. Yes: This is difficult to code and the documentation must be stellar.
Paul Evans, RHIA, CCDS
VOLUME 21 FIRST QUARTER
NUMBER 1 2004, Page 16
Pulmonary Homograft Surgery Status Post Tetralogy of Fallot Repair
Question: This 8-year-old patient was admitted to our facility with a diagnosis of tetralogy of Fallot, which was repaired six years ago. The patient now presents with right ventricular outflow obstruction, pulmonary insufficiency, significant hypoplasia and takeoff stenosis of the left pulmonary artery. She is referred for operative repair. The patient underwent a right ventricular outflow tract reconstruction with a 25-mm pulmonary homograft; a left pulmonary artery reconstruction out to hilum with enlarging patch arterioplasty; a right pulmonary artery takeoff stenosis arterioplasty; cardiopulmonary bypass and intraoperative transesophageal echocardiogram. What is the proper coding and sequencing of the diagnoses and procedures for this case?
Answer: Assign code 747.3, Anomalies of pulmonary artery, as the principal diagnosis. Assign codes 746.02, Anomalies of pulmonary valve, stenosis, congenital; V15.1, Other personal history presenting hazards to health, Surgery to heart and great vessels; and V13.69, Personal history of other diseases, Other congenital malformations, as secondary diagnoses. Do not assign a code for tetralogy of Fallot, since this condition was repaired six years ago. Occasionally, after the first complete repair, residual problems may require additional surgery. Assign code 35.25, Replacement of pulmonary valve with tissue graft, for the insertion of the pulmonary homograft in the RV outflow tract; code 39.56, Repair of blood vessel with tissue patch graft, for the left pulmonary artery reconstruction; code 88.72, Diagnostic ultrasound of heart, for the intraoperative echocardiogram; and code 39.61, Extracorporeal circulation auxiliary to open heart surgery, for the cardiopulmonary bypass.
Merissa,
Leah did a presentation on congenital hearts @ ACDIS 2017 (I believe). If you search the conference materials you should be able to find the presentation...it may speak to some of the coding issues.