CCDS exam sstudy guide, Help!

dsmith12h@aol.com

I am rewieing for the CCDS exam and have the study guide. I need help with a "sample test question". Chapter 2 #7. (This type example was discussed during the conference call 8/18).

A patient is admitted with hypertension and CHF. Appropriate code assignment would:
A. Identify individual codes for each condition.
B. Identify the most appropriate combination code.
C. Require a query for a link between the conditions.
D. Use the combination code with individual codes listed as secondary.

Answer: B

I understood there was an assumed relationship HTN and CKD where the combination code would be used. Because there is not an assumed relationship between HTN and CHF. I chose to query for a link and then you could choose the combination code. If there is no explicit link wouldn't the individual codes be assigned for each condition? I'm confused.

Can someeone help me to understand?

lspryszak

I think you're right: the correct answers would be: query for a link between the HTN and heart disease (not assumed), identify the appropriate combination code (hypertensive heart disease, with heart failure)(which you would have if there IS a link) and then there would also be an individual code for the type of CHF. You would actually want to do all of these things.

Sharp eyes!

lauriehiggins

Oh man, you are freakin' me out a little.

dsmith12h@aol.com

I'm not a coder either. It helps to learn Coding guidelines and if you have acces to coding clinic that's really important. The study guide is through HCPro http://www.hcmarketplace.com/prod-8231/The-CCDS-Exam-Study-Guide.html.

dbutler

The Coding Guidelines (released annually) are available from the CDC:
their ICD home page: http://www.cdc.gov/nchs/icd.htm
the page with the guidelines that apply 10/1/2011:
http://www.cdc.gov/nchs/icd/icd9cm_addenda_guidelines.htm#guidelines

Coding clinics are not available as far as I am aware except by subscription. If you have access to the 3M encoder (and I presume possibly similar products), the coding clinics are available by subscription as part of 3M's reference library that is available with the encoder. Of course, depends on the details of your individual subscription.

Don

lauriehiggins

Thanks, I have that book.

mscholte@chsbuffalo.org

Is there a final answer to the question posed below? Should the correct answer be "C"...query for a link between CHF and HTN before coding this? (? mistake in Study Guide Answer Key? )

evanspx@sutterhealth.org

I think the wording is a bit convoluted, myself. From my perspective,
it is not practical to query for every chart I review with the Diagnoses
of hypertension and heart disease. The number of cases that would be
queried would be 'very' problematic. I do recognize this cause and
effect can exist, and the record must establish the linkage between htn
and heart disease. In my 'real world', I would not institute a query
every time I saw hypertension and heart disease charted...not feasible.


Paul Evans, RHIA, CCS, CCS-P





Paul Evans, RHIA, CCS, CCS-P
Supervisor, Clinical Documentation Integrity, Quality Department
California Pacific Medical Center
2351 Clay #243
San Francisco, CA 94115
Cell: 415.637.9002
Fax: 415.600.1325
Ofc: 415.600.3739

jagin

Speaking as a Coding Manager, I believe the correct answer with the documentation you have, is "A".
If the patient was still in house and you were on the unit you could certainly informally query the physician but if you are final coding and this is all you have the answer has to be "A".

How do we get feedback to the publisher?

Joann Agin

lauriehiggins

I agree.

dbutler

Agreed that this could represent a very large number of queries......however there is the situation where one absolutely will want to query -- acute specified heart failure & where there is either documented or clinical support for CKD. Would then potentially have the Htn heart & CKD combo as the pdx with the acute HF as an MCC.

Apart from that, developing the physician pattern of documentation linkage by query (to raise attention and awareness) when reasonable & practicable will be helpful. Can't help but think of HF & combos as far as I10 prep (it is not too early). A reasonable guideline of when to query might be for those cases where there is not fairly strong evidence of ischemic dz -- if there is, the underlying HF cause is murky as htn vs ischemic dz (or both).

Don

tkreiling

So it appears there is a difference in opinion on whether to query or not but either way doesn't this make the sample question's answer in the study guide incorrect?

evanspx@sutterhealth.org

Don: Good advice - definitely need to establish a 'baseline' (if/then)
type of decision point that can be quantified for 'hypertensive heart
disease'. I like to have a 'strong' clinical basis before I initiate
any query, o/w, the credibility of the query process can be eroded. At
my facility, we see hypertension, CKD and CHF in many, many charts, and
I do believe a query for ALL of these would not be wise unless very
strong evidence-based parameters could be stated on the query to
indicate hypertensive heart disease. Just my opinion...

I think this particular question should be withdrawn (or edited) as it
is very subjective, and there should only be 'one' correct answer. I
can think of several responses to this question, in my mind, all valid.


In my opinion, there are other coding scenarios in the exam test book
that are murky, in particular regarding sequencing of Principal
Diagnosis, that really can't be answered unless more detailed clinical
information in the scenario is stated, to include the focus of the
diagnostic and therapeutic efforts.


Paul Evans, RHIA, CCS, CCS-P



Paul Evans, RHIA, CCS, CCS-P
Supervisor, Clinical Documentation Integrity, Quality Department
California Pacific Medical Center
2351 Clay #243
San Francisco, CA 94115
Cell: 415.637.9002
Fax: 415.600.1325
Ofc: 415.600.3739