Vasogenic edema

edited May 2016 in CDI Talk Archive
Has anyone heard whether AHIMA is looking at revision of this diagnosis to include mass effect?
I am working at a large medical teaching facility and neurosurgeons and neurologist alike have expressed confusion as to why they are queried for clarification of ''mass effect'. They are quite frustrated with it as they tell me "every ICH has vasogenic edema". To them documentation of mass effect is sufficient to describe edema.

Comments

  • I query for edema/hernia if/when the condition meet the UHDDS definition of a secondary reportable condition - brief example, if a pt has a bit of expected edema after a resection of a primary brain cancer and the pt is given Decadron to prevent the expected edema from becoming significant, it would not qualify as a reportable condition, in my opinion. I don't query for it in this case.

    Conversely, if a pt has ICH with a 'significant' midline shift and this is being managed with decardon, ventriculostomy, management of sodium levels, it is significant and separately reportable. However, the terminology 'mass effect' is not helpful. I then query for edema of the brain, possibly even 'hernia' if the neurological consequences to accompany herniation are stated - radiology studies may also support a query for same.

    It is a question of how significant the edema may or may not be for each case. From personal experience, I can tell you my QIO will not routinely endorse the coding of vasogenic edema unless further justification is charted.

  • edited May 2016
    I disagree. If a CT scan of the head mentions vasogenic or cerebral edema I query, whether is is expected or not...no where in any guidelines does it say you can't code it if it is expected

  • It depends upon the situation...some 'edema' is expected in certain
    situations and may be incidental - not separately significant or
    reportable. If an abnormality noted on an exam does not meet the UHDDS
    Definition of a Reportable Condition, it may not be coded.



    The principle was stated in this issue of Coding Clinic, below:



    AHA Coding Clinic* for ICD-9-CM, 4Q 1990, Volume 7, Number 4, Page 25



    Question:

    Is atelectasis following surgery always considered a postoperative
    complication?



    Answer:

    Postoperative atelectasis is often an incidental radiographic or
    physical finding that is frequently a self-limiting condition, in which
    case it would not be coded or reported. If, however, it is associated
    with significant findings, such as fever, or requires further diagnostic
    or therapeutic work up, such as chest x-ray or respiratory therapy, or
    is linked to an extended hospital stay, then it should be reported as
    997.3, Postoperative respiratory complication.



    See the Alphabetic Index under Complications, respiratory,
    postoperative, NEC. Code 518.0 may be added to identify the specific
    complication as atelectasis.



    Paul Evans, RHIA


  • edited May 2016
    Hey Paul,
    Your response brings up another question. Are the coding clinics then allowed to be used as principles, not just as specific examples?
    For instance, the coders at my facility will only use the term exacerbation for an acute or deteriorating condition with CHF and COPD. If any other condition is listed as an exacerbation, they insist it must be queried-that they cannot assume exacerbation means acute and they refuse to code it. My physicians are pretty frustrated from seeing post DC queries written by coders to clarify exacerbation. I thought the coding clinics were guidance and not to be used ONLY for that one example.

    3rd Qtr 2008 says 'The terms "exacerbated," and "decompensated" indicate that there has been a flare-up (acute phase) of a chronic condition.'...so, this seems to me to be another example that with ANY condition that term means the same thing as 'acute' since it's from Dorlands.

    I understand that coding is a lot about interpretation, but surely there are some things we can count on to mean the same thing.


  • I do believe we can take the principle you espoused and apply to various clinical situations. "Coding", and interpreting Coding Clinic, is almost an exercise similar to the principles one founds in legal cases, in my opinion - precedence matters.

    There are 'too many' contradictions one may find in the various issues of Coding Clinic, but in my view, this concept is not restricted only to those cited to you by your coding staff. This is my opinion, and I am sure others may not agree.

    Paul Evans, RHIA, CCS, CCS
  • edited May 2016
    I don't think you can necessarily substitute the term 'deteriorating'
    for acute or exacerbation. For example, do patients with deteriorating
    or end stage COPD necessarily have an exacerbation? Please correct me
    if I am looking at that particular word incorrectly.

    However I totally agree that the use of decompensated or exacerbation
    can be interpreted to mean acute with diagnoses other than COPD and CHF.
    The CC you cited also mentioned Dorlands Medical Dictionary and the
    accepted meaning of those 2 words.


Sign In or Register to comment.