Heart Failure

Unknown
in Clinical & Coding
Would anyone care to share how they were able to educate their
physicians on documenting the specificity of heart failure? Looking for
the best way to approach them.



Thanks.

Patti



Patti Stewart BSN,RN

Clinical Documentation Specialist

Mercy Medical Center

1301 15th Ave. West

Williston, ND 58801

pattistewart@catholichealth.net

Comments

  • robert.hodges2robert.hodges2
    edited April 2016
    I used my standard arguments of continuity of care, severity of illness
    and risk of mortality. It took a little one on one talking, but it has
    worked. I rarely have to query on it any more.



    I'm attaching a copy of my query form which can also be used as an
    educational tool.



    Robert



    Robert S. Hodges, BSN, MSN, RN

    Clinical Documentation Improvement Specialist

    Aleda E. Lutz VAMC

    Mail Code 136

    1500 Weiss Street

    Saginaw MI 48602



    P: 989-497-2500 x13101

    F: 989-321-4912

    E: Robert.Hodges2@va.gov



  • robert.hodges2robert.hodges2
    edited April 2016
    Glad it helped. Have a great weekend!



    Robert



    Robert S. Hodges, BSN, MSN, RN

    Clinical Documentation Improvement Specialist

    Aleda E. Lutz VAMC

    Mail Code 136

    1500 Weiss Street

    Saginaw MI 48602



    P: 989-497-2500 x13101

    F: 989-321-4912

    E: Robert.Hodges2@va.gov



  • vanessa.falkoffvanessa.falkoff
    edited April 2016
    I agree with your interpretation.

    Vanessa Falkoff RN
    Clinical Documentation Improvement Coordinator
    University Medical Center of Southern Nevada
    1800 W Charleston Blvd
    Las Vegas, NV
    vanessa.falkoff@umcsn.com
    office 702-383-7322

    Compassion * Accountability * Respect * Integrity



  • evanspx@sutterhealth.orgevanspx@sutterhealth.org
    edited April 2016
    I do not agree that a patient documented as 'at risk for XX' is coded to said condition....'at risk' does not mean the condition is symptomatic or has occurred. I am interpreting this merely as 'at risk'...as in an obese person may be at risk for DM II, but not yet have developed the DM.

    Thanks, Paul

    Paul Evans, RHIA, CCS, CCS-P, CCDS

    Manager, Regional Clinical Documentation & Coding Integrity
    Sutter West Bay
    633 Folsom St., 7th Floor, Office 7-044
    San Francisco, CA 94107
    Cell: 415.412.9421

    evanspx@sutterhealth.org

  • evanspx@sutterhealth.orgevanspx@sutterhealth.org
    edited April 2016
    To clarify, I agree with the concerns stated by you and your MD advisor. Further, and this is subjective, I would also be reluctant to code the Stage B as stated here given the condition is termed w/o symptoms.

    In my view, patients in this class B do not seem to meet the criteria offered here:

    Definition: "Congestive heart failure is a clinical syndrome that results from the heart's inability to pump the amount of oxygenated blood necessary to meet the metabolic requirements of the body per The Lippincott Manual of Nursing Practice, Sixth edition, page 310.


    Paul Evans, RHIA, CCS, CCS-P, CCDS

    Manager, Regional Clinical Documentation & Coding Integrity
    Sutter West Bay
    633 Folsom St., 7th Floor, Office 7-044
    San Francisco, CA 94107
    Cell: 415.412.9421

    evanspx@sutterhealth.org

  • cmorellcmorell
    edited April 2016
    There appears to be more information that you were not given.

    http://www.ccmdweb.org/dsl/middle.aspx?Slideid=2392&Catid=1025


    The ACC/AHA writing committee has taken a new approach to the classification of HF: the evolution and progression of the disease is now emphasized. Only stages C and D qualify for the traditional clinical diagnosis of HF. (This classification is intended to complement, but not replace, the NYHA Functional Classification.)

    Charlie Morell
  • cmorellcmorell
    And the physicians are confused

    http://www.medscape.com/viewarticle/490041

    Medscape Cardiology
    Incorrect Classification of Patients by the AHA/ACC Stages of Heart Failure
    As many as one third of patients entered into ADVANCENT (the National Registry to Advance Heart Health) to date have been incorrectly classified by the ACC/AHA criteria.

    Charlie Morell
  • belnapcbelnapc
    edited April 2016
    I wouldn't code or query Stage A. Stage B could be defined as chronic CHF and I would either code or query if more information needed. Stage C and D I would code or query if more information needed. I think, like your physician advisor, I would be concerned that the MD's are only going to document the Stage and NY Heart classification but not diagnose CHF in the record - certainly would increase your queries.

    Sincerely,
    Cara Belnap MS, RN, CCDS
    Lead Clinical Documentation Specialist | Health Information Management
    St. Luke's Health System | 190 E Bannock St. | Boise, ID 83712
    Phone: (208) 381-9302| Fax: 208-381-7186 | E-mail: belnapc@slhs.org

  • katysuegood@gmail.comkatysuegood@gmail.com
    edited April 2016
    Ahhh!!! so that makes sense why he is concerned!! Thank you so much Charlie! All they had given me was a little flyer and I hadn’t had a chance to research (same straight to CDITalk after our meeting)

    I don’t have a Medscape account but I am assuming they are specifically talking about this type of classification.

    So my question then becomes what do you do when the physician does an ECHO and documents Class B Systolic Heart Failure? Would you argue it shouldn’t be coded or do we need to figure out a way to get them to document differently? Seems like this could be coded incorrectly all the time....

    Thanks everyone!

    Katy Good, RN, BSN, CCDS, CCS
    Clinical Documentation Program Coordinator
    AHIMA Approved ICD-10CM/PCS Trainer
    Flagstaff Medical Center
    Kathryn.Good@nahealth.com
    Cell: 928.814.9404


  • vanessa.falkoffvanessa.falkoff
    edited April 2016
    Thank you!

    Vanessa Falkoff RN
    Clinical Documentation Improvement Coordinator
    University Medical Center of Southern Nevada
    1800 W Charleston Blvd
    Las Vegas, NV
    vanessa.falkoff@umcsn.com
    office 702-383-7322

  • evanspx@sutterhealth.orgevanspx@sutterhealth.org
    edited April 2016
    Stage B does not meet UHDDS Definition of a reportable condition - I do not feel this should be 'coded' as chronic CHF, at least not as per the definition listed here.




    * The ACC/AHA writing committee has taken a new approach to the classification of HF: the evolution and progression of the disease is now emphasized. Only stages C and D qualify for the traditional clinical diagnosis of HF. (This classification is intended to complement, but not replace, the NYHA Functional Classification.)


    * Stage A: patients who are at high risk for developing HF but have no structural disorder of the heart


    * Stage B: patients with structural disorders of the heart who have never had symptoms of HF


    Paul Evans, RHIA, CCS, CCS-P, CCDS

    Manager, Regional Clinical Documentation & Coding Integrity
    Sutter West Bay
    633 Folsom St., 7th Floor, Office 7-044
    San Francisco, CA 94107
    Cell: 415.412.9421

    evanspx@sutterhealth.org

    [cid:image001.jpg@01CFCCD6.BA1B4250]


  • katysuegood@gmail.comkatysuegood@gmail.com
    edited April 2016
    So you would just educate the coders that even if the provider does an ECHO and states the patient has Stage B Systolic Heart Failure, this is not a codeable diagnosis and to ignore it?

    I agree that the experts are saying that this does not meet the classic definition of HF but the physician is still saying that this is HF using the new criteria. I just find it sticky from a coding perspective because the provider is doing diagnostic testing and stating that the patient has a dx. Generally a dx under these circumstances would be coded. It seems like it's more an example of coding language not matching clinical terminology. It just seems strange to me that we would simply not code something that a provider is specifically stating when testing/monitoring/treatment has been provided.

    Katy Good, RN, BSN, CCDS, CCS
    Clinical Documentation Program Coordinator
    AHIMA Approved ICD-10CM/PCS Trainer
    Flagstaff Medical Center
    Kathryn.Good@nahealth.com
    Cell: 928.814.9404

  • evanspx@sutterhealth.orgevanspx@sutterhealth.org
    edited April 2016
    * The ACC/AHA writing committee has taken a new approach to the classification of HF: the evolution and progression of the disease is now emphasized. Only stages C and D qualify for the traditional clinical diagnosis of HF. (This classification is intended to complement, but not replace, the NYHA Functional Classification.)
    I would meet with a subject matter expert (Cardiologist) and a CDI physician representative and ask them to help - in particular, part of the statement says that only C&D qualify for the 'traditional' diagnosis of HF.

    The coders are going to code any form of HF, if it is noted by a clinician....however, this is not a coding problem, it is a definition problem. I'd ask my MD leaders to try to adopt a universal definition and also to help compose a query that could be used to 'confirm' if clinical CHF is present citing the agreed facility definition.


    Ultimately, if the record states the pt has HF, it will be coded.

    Thanks, PE

    Paul Evans, RHIA, CCS, CCS-P, CCDS

    Manager, Regional Clinical Documentation & Coding Integrity
    Sutter West Bay
    633 Folsom St., 7th Floor, Office 7-044
    San Francisco, CA 94107
    Cell: 415.412.9421

  • cindy.pritchett04cindy.pritchett04
    edited April 2016
    Ditto Paul. I've worked in a facility where the medical staff agreed on a
    clinical definition of a specific dx, participated in the query template
    development, and succesfully followed "their" own guidelines after they
    were implemented. This is definitely a "best practice" recommendation.
    If/when the Cardiology section chief or department rep is on board, the
    group(s) seem to come into alignment with limited push-back. It is a
    winning strategy for sure.

    Always love your insight & recommendations!!

    Cindy Pritchett, CDI Consultant
    MedPartners Staffing
    On Wed, Sep 10, 2014 at 10:08 AM, CDI Talk wrote:

  • katysuegood@gmail.comkatysuegood@gmail.com
    edited April 2016
    Yes. This makes total sense. I agree with you. This is what I told our Doc too. If it says 'heart failure', it will get coded as such. So if you do not want it coded HF, we can't say it.

    As always, thanks so much for working through this with me Paul.

    Katy Good, RN, BSN, CCDS, CCS
    Clinical Documentation Program Coordinator
    AHIMA Approved ICD-10CM/PCS Trainer
    Flagstaff Medical Center
    Kathryn.Good@nahealth.com
    Cell: 928.814.9404

  • evanspx@sutterhealth.orgevanspx@sutterhealth.org
    edited April 2016
    Katy

    You are welcome - thanks for bringing this issue up on the discussion board.....you always make us apply critical analysis.

    Paul Evans, RHIA, CCS, CCS-P, CCDS

    Manager, Regional Clinical Documentation & Coding Integrity
    Sutter West Bay
    633 Folsom St., 7th Floor, Office 7-044
    San Francisco, CA 94107
    Cell: 415.412.9421

    evanspx@sutterhealth.org

    [cid:image001.jpg@01CFCCE2.71A41E50]

  • Snook@fmchealth.orgSnook@fmchealth.org
    edited April 2016
    Thank you so very much. If anyone else has anything else to add please do as I am forwarding all of your responses to the co-coordinator of our CHF unit. They are working toward accreditation.

    Mary L. Snook RN-BC
    Clinical Documentation Improvement Specialist
    Fairfield Medical Center
    740-689-4443



  • Snook@fmchealth.orgSnook@fmchealth.org
    edited April 2016
    Forgive my initial spelling of Hearr Failure. Monday mornings can be overwhelming. I need an automatic spell check just for me.

    Mary L. Snook RN-BC
    Clinical Documentation Improvement Specialist
    Fairfield Medical Center
    740-689-4443



  • kerryseekircherkerryseekircher
    edited May 2016
    I thought it might be that we needed an update to see those clinics, but glad to see I'm not alone.

    Kerry Seekircher, RN, BS, CCDS, CDIP


  • fishdl@shands.ufl.edufishdl@shands.ufl.edu
    edited May 2016
    It's true - this is really great news!

    Coding Clinic 1Q 2016:

    Question:
    Please reconsider the advice previously published in Coding Clinic, First Quarter 2014, page 25, stating that the coder cannot assume either diastolic or systolic failure or a combination of both, based on documentation of heart failure with preserved ejection fraction (HFpEF) or heart failure with reduced ejection fraction (HFrEF). Would it be appropriate to code diastolic or systolic heart failure when the provider documents HFpEF or HFrEF?

    Answer:
    Based on additional information received from the American College of Cardiology (ACC), the Editorial Advisory Board for Coding Clinic for ICD- 10-CM/PCS has reconsidered previously published advice about coding heart failure with preserved ejection fraction (HFpEF), and heart failure with reduced ejection fraction (HFrEF). HFpEF may also be referred to as heart failure with preserved systolic function, and this condition may also be referred to as diastolic heart failure. HFrEF may also be called heart failure with low ejection fraction, or heart failure with reduced systolic function, or other similar terms meaning systolic heart failure. These terms HFpEF and HFrEF are more contemporary terms that are being more frequently used, and can be further described as acute or chronic.
    Therefore, when the provider has documented HFpEF, HFrEF, or other similar terms noted above, the coder may interpret these as "diastolic heart failure" or "systolic heart failure," respectively, or a combination of both if indicated, and assign the appropriate ICD-10-CM codes.


  • martin.conroymartin.conroy
    edited May 2016
    I can retire now.

    Thanks I had not seen this.

    Marty


  • kwilliams@halifaxrmc.orgkwilliams@halifaxrmc.org
    edited May 2016
    Thanks, Kerry!
    Kim Williams, RN
    Clinical Documentation Specialist
    Halifax Regional
    Revenue Management Department
    kwilliams@halifaxrmc.org
    (252) 535-8154
    (252) 535-8937 fax

    [cid:image001.jpg@01D190C9.8F7EC090]





  • dallend@einstein.edudallend@einstein.edu
    edited May 2016
    --=__Part80B6DC21.1__=
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    Thank you so much. I agree with Marty - this is some of the best news I
    have had in my 14 years in CDI.

    Debby


    Deborah A Dallen, BSN, RN, CCDS
    Supervisor
    Clinical Documentation Improvement
    Einstein Medical Center
    Health Information Management
    Phila PA 19141
    215-456-8902
    dallend@einstein.edu

  • kerryseekircherkerryseekircher
    edited May 2016
    It is great news! : )

    Kerry Seekircher, RN, BS, CCDS, CDIP
    Clinical Documentation Program Manager
    Northern Westchester Hospital
    400 East Main Street
    Mount Kisco, NY 10549
    Phone: 914-666-1243
    Fax: 914-666-1013
    kseekircher@nwhc.net

    Visit us at www.nwhc.net
    #NWH100YearsofCare

    A proud member of Northwell Health
    Learn more at Northwell.edu





  • evanspx@sutterhealth.orgevanspx@sutterhealth.org
    edited May 2016
    Dr. Gold

    Thank you for your efforts - I am glad to see AHA issue formal advice that is congruent with clinical practice.





    Paul Evans, RHIA, CCS, CCS-P, CCDS
     
    Manager, Regional Clinical Documentation
    Sutter West Bay
    633 Folsom St., 7th Floor, Office 7-044
    San Francisco, CA 94107
    Cell:  415.412.9421



    evanspx@sutterhealth.org





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