Afib and CHF

Greetings -

     This is a topic that has been discussed before-- but in the ever changing world of CDI - the focus has shifted from un-linking to thrust of care. Frequent CHF admissions/ re- admissions,  due to various reasons, are always a topic of discussion . I am  looking for any tips or trends with the CHF patient that is well controlled and comes back into the in-patient setting  with a decompensation- due to an Afib ----If the physician states the CHF is exacerbated by the AFIB  and both are monitored and treated... how do you sequence ? 

Comments

  • We still abide by the Coding Guideline below, but would be interested in hearing about any other thoughts.

    B. Two or more interrelated conditions, each potentially meeting the definition for principal diagnosis.

    When there are two or more interrelated conditions (such as diseases in the same ICD-10-CM chapter or manifestations characteristically associated with a certain disease) potentially meeting the definition of principal diagnosis, either condition may be sequenced first, unless the circumstances of the admission, the therapy provided, the Tabular List, or the Alphabetic Index indicate otherwise

  • It depends upon the acuity of each condition,  and the 'intensity' of efforts spent to evaluate, monitor and treat A versus B.


  • Thank you for the insight and feedback . When I think of the "Thrust of Care" for each -- CHF will more often then not end up as the more intensely treated of the 2 diagnosis.  Afib may require a drip to control the rate while CHF may require CXR , med management with IV lasix / pulmonary assessment. ect.
    I am getting push back from the physician as to why the Afib is not primary when they believe they have indicated this with their clinical judgment through documentation . It gets to be a very slippery slope .
    How can I, as the CDS,impact or bridge the gap between Coding Guidelines and clinical  picture.



     
  • edited April 16
    Thank you for the insight and feedback . When I think of the "Thrust of Care" for each -- CHF will more often then not end up as the more intensely treated of the 2 diagnosis.  Afib may require a drip to control the rate while CHF may require CXR , med management with IV lasix / pulmonary assessment. ect.
    I am getting push back from the physician as to why the Afib is not primary when they believe they have indicated this with their clinical judgment through documentation . It gets to be a very slippery slope .
    How can I, as the CDS,impact or bridge the gap between Coding Guidelines and clinical  picture.



     
    When both A fib (with RVR?) and heart failure (documented type, of course) decompensation are both POA, then either would typically qualify as principal diagnosis; A fib with RVR typically requires Amiodarone drip and close monitoring and heart failure exacerbation requires IV diuresis, oxygen, close monitoring.

    You really have to look at each diagnosis from a clinical point of view and determine which condition required the inpatient admission from a medical necessity standpoint. That usually helps our docs get the picture we are trying to portray. 

    Richard
  • Perfect answer Richard! Especially the last sentence. 
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