CHF question

Unknown
in CDI Talk Archive
I was just reviewing a coding summary. Pt came in w/DOE, weight gain. I was expecting to see the final code 293 CHF without CC/MCC. The coder used 404.91 as the PDx, "Hypertensive heart and chronic kidney disease w/heart failure unspecified." The acute on chronic systolic heart failure as the MCC. So it ends up in DRG 291 CHF w/MCC. It seems illogical to my mind - CHF with CHF. I ran it through the encoder and it came up the same. I can't believe I haven't run across this before.

Linnea Thennes, RN, BS, CCDS
Clinical Documentation Specialist
Centegra Hospital - McHenry
815.759-8193
lthennes@centegra.com


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Comments

  • Unknown
    edited May 2016
    I have come across this a few times also. It didn't make sense to me
    either.




  • kari.eskenskari.eskens
    edited May 2016
    The code assignment is correct. Please see below for the official coding guidelines on this topic.

    [cid:image001.png@01CBD1D6.BA166EF0]

    Kari L. Eskens, RHIA
    BryanLGH Medical Center
    Coding & Clinical Documentation Manager

    From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
    Sent: Monday, February 21, 2011 2:09 PM
    To: Kari Eskens
    Subject: RE: [cdi_talk] CHF question

    I have come across this a few times also. It didn't make sense to me either.


  • Unknown
    edited May 2016
    Kari - thank you so much for sharing this, exactly what I needed to clear up the mud!

    From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
    Sent: Monday, February 21, 2011 2:51 PM
    To: Thennes, Linnea
    Subject: RE: [cdi_talk] CHF question

    The code assignment is correct. Please see below for the official coding guidelines on this topic.

    [cid:image001.png@01CBD1D6.FFD29B30]

    Kari L. Eskens, RHIA
    BryanLGH Medical Center
    Coding & Clinical Documentation Manager

    From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
    Sent: Monday, February 21, 2011 2:09 PM
    To: Kari Eskens
    Subject: RE: [cdi_talk] CHF question

    I have come across this a few times also. It didn't make sense to me either.


  • Unknown
    edited May 2016
    Its one of the great mysteries of Coding...

    NBrunson, RHIA, CCDS


  • dallend@einstein.edudallend@einstein.edu
    edited May 2016
    I tell my orientees on their first day - "Coding doesn't always make sense - it does not always appear logical - it is what it is. As long as everyone follows the rules, we are okay."


  • ssalinasssalinas
    edited May 2016
    A number of coding guidelines are in play with the CHF and hypertension relationship.

    · The physician must state the CHF is due to hypertension in order to use the 402.x1 or 404.x1 codes as the principal diagnosis. (A statement of HCVD with CHF also listed works.) There is not an assumed causal relationship between CHF and HTN as there is with CRF/CKD and HTN.

    · Both CHF and either systolic or diastolic (or both systolic and diastolic) must be documented and a term such as acute or decompensated must be associated with one of the 3 diagnoses to get the MCC.



    I think the logic behind this is that not all CHF patients have an acute exacerbation of systolic &/or diastolic heart failure and not all CHF is associated with hypertension.



    Sharon





  • dvitalone1dvitalone1
    edited May 2016
    Is there a coding clinic related to capturing decompensated as acute? It was my understanding that you cannot code decompensated CHF and must clarify that this means acute to capture MCC


    Dawn



  • Unknown
    edited May 2016
    Yes.

    Exacerbation of diastolic congestive heart failure
    Coding Clinic, Third Quarter 2008 Page: 12 Effective with discharges: September 19, 2008


    Question:

    When a patient with a known history of CHF is admitted with an exacerbation of diastolic congestive heart failure, how would this be coded?

    Answer:

    Assign code 428.33, Diastolic heart failure, acute on chronic, and code 428.0, Congestive heart failure, unspecified. Dorland's Medical Dictionary defines "exacerbation" as an increase in the severity of disease or any of its symptoms. The terms "exacerbated," and "decompensated" indicate that there has been a flare-up (acute phase) of a chronic condition.





    Charlene

    From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
    Sent: Thursday, February 24, 2011 7:22 AM
    Subject: RE: [cdi_talk] CHF question

    Is there a coding clinic related to capturing decompensated as acute? It was my understanding that you cannot code decompensated CHF and must clarify that this means acute to capture MCC


    Dawn



  • ssalinasssalinas
    edited May 2016
    Also have to remember if the statement is only decompensated CHF, then it is only CHF. There is no code for acute or decompensated CHF other than 428.0. Diastolic or systolic failure/dysfunction has to be in the equation. If not, query!



    Sharon


  • david.smithdavid.smith
    edited May 2016
    In my opinion, it would not apply to a decompensation of chronic cor pulmonale. I would probably want to query or talk with the physician to determine the exact meaning of “decompensated” when used with cor pulmonale. Is it really Acute Cor Pulmonale or could it be an acute right sided CHF. In researching this topic, it appears from the literature that acute cor pulmonale has some very specific causes, presentation and is of a sudden onset. It doesn’t seem to be a progression/exacerbation of the chronic form, but I think it would be great query opportunity and a chance for the CDI/coders to get some insight from the physician.



    Acute cor pulmonale (ACP) can be defined as a clinical situation in which the right ventricle (RV) is suddenly subjected to an excessive afterload. ACP is essentially seen during massive pulmonary embolism (PE), or in the setting of acute respiratory distress syndrome (ARDS). In these two situations, the right ventricular outflow impedance is suddenly increased, which reduces the ejection volume, producing right ventricular dilatation by augmentation of the end-systolic volume. Thus, ACP combines systolic and diastolic overload of the RV.




  • Unknown
    I'm surprised that coders were not aware of decompensated for Heart Failure. It came out around Oct. 2007 which was the release of MS DRG's and the need for further documentation for Heart Failure (Systolic/Diastolic). We were quite relieved when we found out we could "combine" phrases to put those particular diagnoses together, for example - Hx of CHF, systolic dysfuction, acute exacerbation = Ac on Chr Systolic Heart Failure.

    I could not find an "overall" rule for decompensation but here is another Coding Clinic for "Decompensated COPD":

    AHA Coding Clinicâ for ICD-9-CM, 3Q 2002, Volume 19, Number 3, Pages 18-19

    Question:

    We are seeing the terms “decompensated COPD,” or “decompensated COPD with exacerbation.” Is it appropriate to assign code 491.21 in these cases?

    Answer:

    Assign code 491.21, Obstructive chronic bronchitis, With acute exacerbation, for “decompensated COPD.” Decompensated COPD is an exacerbation of COPD.

    However I would never just apply it overall unless I had something to back it up in writing. I'll reseach for any material that addresses decompensation overall. Perhaps another colleague will reply with the answer.

    NTB
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