FW: 6485343
Please help me understand. If a physician documents "Mild congestive heart failure contributing to symptomology as well related to diastolic dysfunction" how would you all code this? I am sorry I am beating a dead horse but I am getting a lot of hesitancy from our coders here related to this subject and the coding supervisor tells me to "put it on CDI talk and let's see what they say." There is documentation of CHF exac and diastolic dysfunction throughout record and pt was treated for the CHF but the term acute diastolic heart failure is never written all together in the same sentence . Thanks for your input
Here is my coder's reasoning: According to coding clinic "Exacerbation of Diastolic CHF" should be coded to 428.33 "Diastolic Heart Failure, acute on chronic" and code CHF 428.0.
There is no where in the progress notes that state the patient has "Acute Diastolic CHF". I found CHF exacerbation on page 20, 9 and 5; page 13 and page 1 ,CHF with diastolic dysfunction. Diastolic dysfunction with CHF whether compensated or decompensated codes to 428.0 CHF. Unless I have definitive information that "diastolic dysfunction" and "diastolic heart failure" are the same, I cannot code it to diastolic heart failure.
DAWN
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Here is my coder's reasoning: According to coding clinic "Exacerbation of Diastolic CHF" should be coded to 428.33 "Diastolic Heart Failure, acute on chronic" and code CHF 428.0.
There is no where in the progress notes that state the patient has "Acute Diastolic CHF". I found CHF exacerbation on page 20, 9 and 5; page 13 and page 1 ,CHF with diastolic dysfunction. Diastolic dysfunction with CHF whether compensated or decompensated codes to 428.0 CHF. Unless I have definitive information that "diastolic dysfunction" and "diastolic heart failure" are the same, I cannot code it to diastolic heart failure.
DAWN
____________________________________
This message and attachment(s), if any, is intended for the sole use of the individual and/or entity
of which it is addressed, and may contain information that is privileged,confidential and prohibited
from disclosure under applicable law. If you are not the addressee, or authorized to receive this on
behalf of the addressee, you are hereby notified that you may not use, copy, disclose or distribute
to anyone this message or any part thereof. If you have received this in error, please immediately advise
the sender by e-mail and delete this information and all attachments from your computer and network.
Thank you.
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Comments
If you also have mention of CHF exacerbation you then get acute on chronic diastolic CHF.
Charlene
Dawn
Coding Clinic 4Q 2002
Question:
Coding Clinic, First Quarter 1993, pages 19-20, advised us to code a
diagnosis of congestive heart failure due to diastolic dysfunction due to
hypertension with code 402.91, Hypertensive heart disease, unspecified
with congestive heart failure. Now that the heart failure codes have been
revised effective October 1, 2002, how would this condition be coded with
the new codes?
Answer:
You will now need three codes to completely describe this diagnosis.
Assign codes 402.91, Hypertensive heart disease, unspecified with heart
failure; 428.30, Diastolic heart failure, unspecified; and 428.0,
Congestive heart failure, unspecified. The two additional codes provide
the specificity required to report that the heart failure was diastolic
type and congestive.
Stacy Vaughn, RHIT, CCS, CCDS
Data Support Specialist/DRG Assurance
Aurora Baycare Medical Center
2845 Greenbrier Rd
Green Bay, WI 54311
Phone: (920) 288-8655
Fax: (920) 288-3052
Systolic dysfunction with congestive heart failure
Coding Clinic, First Quarter 2009 Page: 8 Effective with discharges: March 27, 2009
Question:
The patient is documented as having systolic dysfunction with acute exacerbation of congestive heart failure (CHF). Can this be coded as acute systolic heart failure with congestive heart failure?
Answer:
Assign code 428.0, Congestive heart failure, unspecified and code 428.23, Systolic heart failure, Acute on chronic. Acute exacerbation of a chronic condition (heart failure) is coded as acute on chronic.
ICD-9-CM's Alphabetic Index provides the following direction for systolic dysfunction with heart failure:
Dysfunction
systolic 429.9
with heart failure -- see
Failure, heart
Additionally, congestive heart failure is not an inherent component of systolic or diastolic heart failure. When the diagnostic statement lists congestive heart failure along with either systolic or diastolic heart failure, two codes are required to report the specific type of heart failure: congestive, diastolic, and/or systolic. This advice is consistent with that published in Coding Clinic, Fourth Quarter 2002, pages 52-53 and Fourth Quarter 2004, page 140.
Sharon Salinas, CCS
Extension 3336
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Tuesday, March 01, 2011 8:32 AM
To: Salinas, Sharon
Subject: RE:[cdi_talk] 6485343
Per Coding Clinic, if you have mention of diastolic dysfunction and CHF you combine them
Greta Goodman
Clinical Documentation Improvement Specialist
Health Information Management
Virginia Hospital Center
1701 North George Mason Drive
Arlington, VA 22205
703-558-5336
ggoodman@virginiahospitalcenter.com