Decompensated vs Compensated CHF
Good morning,
If Coding Clinic from 2008 allows for the term decompensated heart failure to code to an acute phase of a chronic condition does compensated heart failure indicate a chronic condition only? Is your organization submitting a query for the term chronic if "compensated systolic/diastolic heart failure" is documented?
"Under Coding Clinic advice from 2008, the term “decompensated” indicates an acute phase of a chronic condition. However, under ICD-10-CM heart failure codes the term “decompensated” as synonymous with “acute-on-chronic.” Furthermore, while most clinicians also consider the term “exacerbated” to be synonymous with “acute-on-chronic” as well, Coding Clinic neglected to address this terminology leading to concerns related to denials."
Thanks,
Tracy Boldt
Comments
While the ICD updates neglected to included the term "exacerbated" the term itself has not changed meaning in the oxford English dictionary since the previous I9 (1st Q 2009 pgs 8 and 17) coding clinic stating that exacerbated did indeed mean acute on chronic. Any argument to the contrary is auditor trickery.
However if you have physicians documenting "compensated heart failure" a query will likely be needed simply because it is not an indexable term which is going to cause coding problems in spite of the fact that we all know what it means.
2nd Q 1990 pgs 16 to 18 says this
"Compensated versus decompensated heart failure. These terms are sometimes used to further describe the ability or inability of the heart to handle the increased work load. The heart muscle commonly develops compensatory mechanisms on a chronic basis such as cardiac hypertrophy, ventricular dilatation, raised atrial pressures, or increased force of contraction. When these compensatory mechanisms become inadequate to maintain the increased work load, decompensation of the heart function results.."
You will also want to watch for the term "congestive" as that generally indicates that it is acute.
While I would assume compensated heart failure = chronic heart failure. An auditor is going to attack it purely based on indexing.