cardiomyopathy guidelines
Does anyone have set guidelines as to when to query versus when not to query for the type of Cardiomyopathy? Obviously, the diagnosis would need to meet the definition of a secondary diagnosis. Have to have an echo? Only send to cardiologist? etc
Thanks
Comments
This has been a struggle for me for years. In many cases a patient with cardiomyopathy presents as a CHF/HF patient, gets worked up as a HF patient, treated as a HF patient and goes home with similar instructions as a HF patient. Thus the doctors document HF and never mention the cardiomyopathy (even when it is clearly present).
I am not aware of any coding clinic or excludes 1 note which indicates that cardiomyopathy is integral to HF, in fact many HF patients do not have cardiomyopathy meaning that according to general coding conventions, it SHOULD be separately reported when present in order to fully tell the patient's story.
When it gets severe, physicians will start documenting it clearly in relation to the heart failure but they tend to completely ignore the mild and moderate levels except in very rare situations (congenital obstructive hypertrophic in a young patient).
All heart failure eventually causes some hypertrophy/atrophy/dysfunction of the heart so in some ways severe heart failure MAY be looked at clinically as integral. In this way I am ambivalent about secondary cardiomyopathies (which most are), but we ABSOLUTELY should be going after any primary cardiomyopathy (where the cardiomyopathy happened first and THEN heart failure developed).
The evaluation, monitoring, treatment, nursing services and length of stay will be similar to that of the heart failure already being documented so there is a resource utilization argument to be made that you are "double dipping" if you pick it up as a CC, however if it is not changing the DRG (say it is your 2nd or 3rd CC) then how can it be upcoding just to give complete and accurate ICD 10 coding?
I do believe you will likely need to focus this towards hospitalists or cardiologist. I also believe queries should never be placed unless you have the clinical evidence within the record to support the query (and to suggest that the MD could even answer the question). This means you will probably need a new or recent echo and some documentation of the patient's history. I think alcoholic and drug induced cardiomyopathy have real potential for query since there is a history there which is reasonably contributing to the condition and in accordance with the clinical truth. Restrictive, dilated and hypertrophic should be apparent on the echo and addressable by a cardiologist. "Other" is an option if the record suggest the causes of the cardiomyopathy but it is not an etiology that can be named in ICD 10. Unspecified however is nebulous and could result in denials at times, ESPECIALLY if it is only a secondary result of a known HF.
Interested to see what others think about this.