Afib with RVR vs Chronic afib as PDX
We have a patient where the provider documented in the H&P history a diagnosis of "history of chronic afib". The patient was admitted with afib with RVR and on the d/c summary and PN throughout the afib with RVR is documented. No where else does he mention the chronic afib. The coder wants to take it to the chronic afib due to the H&P information. I realize it is an acute on chronic issue but since there is no code for acute on chronic afib, or exacerbation of afib or with RVR, do we code the chronic as PDX or do we use the unspecified code for afib? We have tried to research coding clinics, guidelines, etc. but can find nothing to support or explain the coders choice. Could you please clarify and provide the support for the decision if available, or at least guide me in where to find the information. Thank you.
Comments
https://acls-algorithms.com/rhythms/supraventricular-tachycardia/
If the rate is below 150bpm you may be stuck with unspecified, although we used to also call the RVR paroxysmal afib if it had a variable rate and went up above 130 frequently, that won't matter much because Paroxysmal gets no credit under the IPPS. It may help in other methodologies.
One other point, i have never actually tried this but it may be possible according to the general code guidelines to report both the chronic and acute forms of the disease. That is the suggested coding for situations where there is no combo code. Under that view you could have chronic afib and paroxysmal afib on the same record.
There isn't any justification here for trying to get to persistent afib that i can see however as the diagnosis is already established as being chronic and although ICD 10 doesn't list them as excludes 1s, the clinical definitions make them appear mutually exclusive.
Is there a reason why you WANT it to be unspecified in particular? I don't see a reason to do that but I am interested. If you are struggling with the coders desire to use Chronic instead of unspecified that is a basic rule of coding: Coding 101: Never use an unspecified form of a diagnosis if a more specific form of the diagnosis is available. Always code ICD 10 codes to the highest level of specificity available. It shouldn't be to hard to find the reference as it is right in the official coding guidelines, it is mentioned throughout various coding clinics, it's in the AHIMA coding handbook etc. Also the coder really isn't allowed to select "unspecified" when it is in fact specified in the record..that is in the coding conventions and definitions of ICD 10 that coders are required to learn. The nearest thing to "acute on chronic" as an indexed entry would be "other" as it is a named condition not separately classified. (and there is no a-fib Other in ICD 10). This would however be superceded by the aforementioned guideline that if i a condition is classified as both acute and chronic and there is no combo code available in ICD 10, the coder is to code both conditions and sequence the acute version first.
You can find the guidelines here: https://www.cdc.gov/nchs/data/icd/10cmguidelines_fy2018_final.pdf
Those guidelines are always REQUIRED reading for my CDS for just this type of a reason.
Pg. 15: "Acute and Chronic Conditions If the same condition is described as both acute (subacute) and chronic, and separate subentries exist in the Alphabetic Index at the same indentation level, code both and sequence the acute (subacute) code first."
Pg 10: b. “Unspecified” codes Codes titled “unspecified” are for use when the information in the medical record is insufficient to assign a more specific code."
Pg 18: "When sufficient clinical information isn’t known or available about a particular health condition to assign a more specific code, it is acceptable to report the appropriate “unspecified” code (e.g., a diagnosis of pneumonia has been determined, but not the specific type)."