Is "concern for" an acceptable term when used to qualify a final diagnosis at the time of discharge like possible, probable, likely.....? I'm getting conflicting information regarding it's use.
Search the forum for "concerning for" and it will bring up a recent discussion. It appears that many Coder's will not pick up diagnoses listed as concern for so the CDI teams are querying to confirm those diagnoses.
"Concern for' means a condition may be one of many on a potentially long list of conditions, whereas, Rule Out should mean the staff have concluded after study that it is reasonable to believe a condition may be present, and that a w/u and conclusion support said condition.
Possible, Problable, Likely, Suspected have been the only terms that I know of to be able to code out the diagnosis with this being carried through to the Discharge Summary.
Thanks Kelly, I think something to consider is the totality of the guideline which concludes with the following sentence:
"H. Uncertain Diagnosis If the diagnosis documented at the time of discharge is qualified as “probable”,
“suspected”, “likely”, “questionable”, “possible”, or “still to be ruled out”, or other
similar terms indicating uncertainty, code the condition as if it existed or was
established. The bases for these guidelines are the diagnostic workup, arrangements for further workup or observation, and initial therapeutic approach that correspond
most closely with the established diagnosis." ICD-10-CM Official Guidelines for Coding and Reporting FY 2017 Page 101 of 114
So if the provider discussed follow-up care related to the diagnosis for which there is "concern" or is "concerning" then it should fulfill the intent of the guideline. Of course, it is always best to get consensus from your organization's compliance and coding manager to see if there is an unwritten "policy" for your particular organization.
I discussed this with my physician advisor yesterday and he was very strongly supportive of physicians using "concerning for" as an acceptable term for an uncertain diagnoses. He made clear that to him, "concern for" is in the continuum: -->concern for --> possible --> probable --> confirmed.
Discussing it with the inpatient coders yesterday, they too agreed that they hold "concern for" as an uncertain diagnosis and if documented as such on the D/C summary they will code it and defend it.
I am not so sure, I would love to see some consensus guidance from our professional organization.
Regarding the statement "concerning for ___________",and based on clinical circumstances,
findings, and sound professional judgment informed by evidence-based medicine, please clarify the status of the
condition:
___ was
present on admission and is now resolved
___ was
present on admission and is still being monitored, evaluated, or treated
As a 20 year coder myself, I find the phrase "concern for" to be "sketchy". However, as someone who has been using the English language for 45 years, I find the phrase "concern for" to most likely meet the criteria of "uncertain". Just be advised that many industry experts don't even like "possible" (see my entry in this forum). If "possible" is up for debate then I assume "concern for" could be. To those who only accept the exact terms listed in the guidance I would point out that the guidance SPECIFICALLY calls out "other similar terms". The smarty-pants in me would point out that if you only use the examples given and ignore the full language of the entry then you are picking and choosing which parts of the clinic you accept which basically makes you out of compliance. Are we having fun yet?
If the BODY of the record is sufficient to allow the coder to reach a conclusion is there a federal law prohibiting them from doing so?
Remember that in a dispute with CMS about coding, a final
decision would be made by a judge, not a coder or a physician. A judge is going
to look at the regulatory framework and try to determine what it requires. The
regulatory framework is the key to getting to the bottom of this issue.
Comments
Search the forum for "concerning for" and it will bring up a recent discussion. It appears that many Coder's will not pick up diagnoses listed as concern for so the CDI teams are querying to confirm those diagnoses.
Jeff
We discourage MD usage of it and encourage them to stick to suspected, likely, probable
"Concern for' means a condition may be one of many on a potentially long list of conditions, whereas, Rule Out should mean the staff have concluded after study that it is reasonable to believe a condition may be present, and that a w/u and conclusion support said condition.
Paul Evans, RHIA, CCDS
Possible, Problable, Likely, Suspected have been the only terms that I know of to be able to code out the diagnosis with this being carried through to the Discharge Summary.
Tammie Williamson RN,BSN,CCDS
We do not consider it synonymous to "probable or possible"
We query for clarification
http://blogs.hcpro.com/acdis/2015/06/qa-documenting-uncertain-diagnoses/
"H. Uncertain Diagnosis
If the diagnosis documented at the time of discharge is qualified as “probable”, “suspected”, “likely”, “questionable”, “possible”, or “still to be ruled out”, or other similar terms indicating uncertainty, code the condition as if it existed or was established. The bases for these guidelines are the diagnostic workup, arrangements for further workup or observation, and initial therapeutic approach that correspond most closely with the established diagnosis." ICD-10-CM Official Guidelines for Coding and Reporting FY 2017 Page 101 of 114
So if the provider discussed follow-up care related to the diagnosis for which there is "concern" or is "concerning" then it should fulfill the intent of the guideline. Of course, it is always best to get consensus from your organization's compliance and coding manager to see if there is an unwritten "policy" for your particular organization.
Hope it help, Cheryl.
Discussing it with the inpatient coders yesterday, they too agreed that they hold "concern for" as an uncertain diagnosis and if documented as such on the D/C summary they will code it and defend it.
I am not so sure, I would love to see some consensus guidance from our professional organization.
See many of your folks in May!!
Mark Dominesey
Children's National Medical Center
When in doubt send a query out!
Regarding the statement "concerning for ___________",and based on clinical circumstances, findings, and sound professional judgment informed by evidence-based medicine, please clarify the status of the condition:
___ was present on admission and is now resolved
___ was present on admission and is still being monitored, evaluated, or treated
___ was ruled out
___ still a likely, suspected, probable diagnosis
___ Other
___ Unable to determine
If the BODY of the record is sufficient to allow the coder to reach a conclusion is there a federal law prohibiting them from doing so?
Remember that in a dispute with CMS about coding, a final decision would be made by a judge, not a coder or a physician. A judge is going to look at the regulatory framework and try to determine what it requires. The regulatory framework is the key to getting to the bottom of this issue.