Presumed prosthetic valve endocarditis

Sheri.Sanford

Hi,
    I have a question concerning a documented "presumed prosthetic valve endocarditis" 
1st set of blood cultures grew staph epidermis, repeat blood cultures-negative. Tee - no evidence of valvular vegitation or pacer infection. ID states- "regardless considering patients risk factors and protracted bacteremia, ID will treat as Endocarditis"
Can endocarditis be coded ?

evanspx@sutterhealth.org

1.  I am obviously NOT an MD, but clinically, this sounds very dubious and I’d expect a 3rd party to challenge the clinical validity of this condition.  The fact this is staph epidermis strongly suggest this is a contamination rather than true infection of any type.  Speaking anecdotally, I do not recall this condition being diagnosed with  NO vegetation, either.

  Perhaps someone with more clinical knowledge on this condition can provide further insights?  

2.  However, strictly speaking, the coding rules allow a presumed condition to be coded directly as follows:

If the diagnosis documented at the time of discharge is qualified as “probable,” “suspected,” “likely,” “questionable,” “possible,” or “still to be ruled out,” “compatible with,” “consistent with,” or other similar terms indicating uncertainty, code the condition as if it existed or was established.  The bases for these guidelines are the diagnostic workup, arrangements for further workup or observation, and initial therapeutic approach that correspond most closely with the established diagnosis. 

Remember, however, that this guideline is only applicable to inpatient admissions to short-term acute, long-term care, and psychiatric hospitals.

Paul Evans, RHIA, CCDS

morris-jeff@CooperHealth.edu

Agree with Paul on #1 and #2. I have seen Md's document that regardless of negative cultures or findings they are going to treat as that condition or document it as presumed. I think if you have such a statement from your MD's that you go ahead and code the condition as long as it makes it to the discharge summary. If they are going to treat the patient as they have endocarditis with an appropriate course of antibiotics and state that the patient has risk factors then I think they are doing their best to tell someone "it really doesn't look like it but the risk is high so we are going to treat".

Of course, if you have the luxury of a Physician Advisor this would probably be a good case for them to review and probably a good learning experience for all.

Jeff