Vfib with removal of cross clamp
I have asked a similar question in the past, but I am hoping CDIs that have heart centers and complete bypass and valve replacements can provide some additional information. Coding rules, guidelines, and coding clinic support the coding of ventricular fib when documented in the operative report of a cardiothoracic surgery. I actually posed the question myself to coding clinical and the response I got back was yes but to clarify if it was a complication. We have several cardiothoracic surgeons that will purposefully leave out the type of fibrillation that occurs with removal of the cross clamp trying to avoid a query, unfortunately it does not alleviate the need for a query. However, several have actually stated to our CMO that they leave out the fibrillation completely so they are not asked about it. I have provided multiple references on the topic including the fact that research is still on-going on how to prevent vfib with cross clamp removal and that several treatment modalities have indeed decreased the odds of vfib during this time (magnesium, amiodarone, for example). I have inquired of several heart centers about their process. Brigham and Women's tolde me if the vfib happens with cross clamp removal and is corrected with one defibrillation or manual massage, they do not code it. However, if it requires more intervention than that, they do code it and query for a complication. National Healthcare codes it if it is documented and also queries if it is a complication. I would love to get some numbers from heart institutes regarding total number of cardiothoracic DRGs and then those that had vfib documented and coded. (DRGs 163,164, 165, 166, 167, 168,216,217,218,219,220,221,228,229,231,232,233,234,235,236,306,307 and diagnosis code of I49.01 (vfib). Anyone out there willing to provide some numbers and or your process?
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Hello there- I was working on some research related to capturing VF when documented in the OP report for our CABGs and came across your chat above. We do capture the VF when it is documented but we too are noticing quite a bit of push back from our CTS if we query for the rhythm that was treated when we see the patient receiving defib coming off of bypass and treatment with lidocaine. We also speculate that providers do not want to document the rhythm being treated- they feel it is inherent to coming off bypass and we should not be capturing the code. They have also asked if it part of the STS database. I'm not familiar with their STS database so will need to do more research. It's interesting that coding clinic supported coding the VF but also recommended to clarify if it was a complication? I was hoping you could share any articles, etc supporting capturing the code. I don't have numbers to share with you as we don't track and honestly I don't believe it occurs often....as I don't see 'defib' or 'cardioversion' documented often in their op notes....most patients coming off bypass go into NSR immediately per the documentation. Anything you are willing to share regarding this topic would be greatly appreciated. nichelle.labarge@multicare.org