sequencing question
What is the proper sequencing for this scenerio?
Patient comes in with large pleural effusion secondary to decompensated CHF, acute on chronic, diastolic. Also has hypertensive heart disease and CKD 3. Patient underwent thoracentesis with 1600 cc fluid removed.
Charlene
Patient comes in with large pleural effusion secondary to decompensated CHF, acute on chronic, diastolic. Also has hypertensive heart disease and CKD 3. Patient underwent thoracentesis with 1600 cc fluid removed.
Charlene
Comments
Pleural effusion is not usually reported in cases of CHF/left heart
failure, as, it is commonly seen in the disease. However, there are
instances when pleural effusion code 511.9 may be assigned. For example;
After confirmation of the pleural effusion, a therapeutic thoracentesis
or chest tube is necessary to drain the excess fluid.
Sequenced:
404.91- hypertensive heart and kidney dz
585.3 ckd 3
428.33 chf, acute on chronic diastolic
511.9 pleural effusion
Thank you,
Tiffany
Better Documentation equals better patient care.
So the hypertensive heart & kidney disease would be PDx?
Charlene
the pt, the CHF is the underlying cause. Per Coding Clinic:
Heart Failure
Effective October 1, 2002, significant changes have been made in the
reporting of hypertensive heart disease and heart failure. Specifically,
the fifth digits for categories 402, Hypertensive heart disease, and
404, Hypertensive heart and renal disease, have been modified from
congestive heart failure to heart failure. Instructional notes have also
been added to these categories to use an additional code to report the
specific type of heart failure.
Effective October 1, 2002, category 428, Heart failure, has also been
modified to provide greater specificity regarding the type of heart
failure (congestive, systolic, diastolic, and combined diastolic and
systolic). In addition, these subcategories have been further divided to
identify whether the heart failure is unspecified, acute, chronic, or
acute on chronic. Acute on chronic refers to the patient having chronic
heart failure and now has an acute flare-up on top of it. These changes
will allow improved tracking of patients by the more specific
distinctions of this disease. Determination of whether the heart failure
is acute, chronic, or, acute on chronic, is based on physician
documentation.
Heart failure occurs when the heart is unable to pump sufficient blood
throughout the body. The term congestive heart failure is often
mistakenly used interchangeably with heart failure. Congestion,
pulmonary or systemic fluid build-up, is one feature of heart failure,
but it does not occur in all patients. Common symptoms of heart failure
are edema, fatigue, and dyspnea at rest or during exercise.
There are two main categories of heart failure: systolic and diastolic.
Within each category, the symptoms may differ from patient to patient.
In 1994, the Agency for Healthcare Research and Quality (AHRQ) in
association with the American Heart Association and the American College
of Cardiology, developed guidelines defining systolic and diastolic
dysfunction. Differentiating between systolic and diastolic dysfunction
is essential because their long-term treatments are different.
Systolic heart failure occurs when the ability of the heart to contract
decreases. The heart is unable to pump out adequate amounts of blood
during contraction (systole). Blood coming from the lungs into the heart
may back up and cause fluid leakage into the lungs causing pulmonary
congestion. Treatment consists of ACE inhibitors, digoxin, diuretics and
beta blockers.
Diastolic heart failure occurs when the heart has a problem relaxing
between contractions (diastole) to allow enough blood to enter the
ventricles. The heart cannot fill with sufficient blood because the
heart muscle is stiff and unable to relax. This may lead to fluid
accumulation, especially in the legs, ankles and feet. Some patients may
also have lung congestion. The treatment depends on the underlying
cause. Beta blockers and calcium channel blockers are often used when
diastolic dysfunction is due to ischemia or hypertension.
If a patient has hypertensive heart disease with congestive heart
failure due to hypertension, it is appropriate to assign a code for the
hypertensive heart disease (402.01, 40211, or 402.91) along with the
code for congestive heart failure (428.0). Additional codes should be
added if the heart failure is known to be systolic (428.20-428.23),
diastolic (428.30-428.33) or combined systolic and diastolic
(428.40-428.43).
Thank you,
Tiffany
Better Documentation equals better patient care.
My poor brain is having a hard time seeing why hyptertensive heart & kidney disease would be PDx instead of the CHF. Seems to me that the pleural effusion/CHF is what caused the admission.
Charlene
code for hypertensive chf the htn ckd & chf is the winner.
I understand how you feel. Every time I think I understand ICD9, they
throw me a loop!
Thank you,
Tiffany
Better Documentation equals better patient care.
If the physician did not provide the clinical cause and effect relationship IN the documentation, then my understanding was you could not assume the linkage of htn and HF to be able to use the combo code.
Don
original question, it seemed to me that the relationship was made. I
could have read it wrong....Early morning!
Thank you,
Tiffany
Better Documentation equals better patient care.
Hope my point will still be helpful to the discussion as other's may also miss that!
Don