Complication of a heart valve

bbain98bbain98
in CDI Talk Archive
I have a question. If a patient comes in with a complication of a heart valve (ie dehiscence) and it is stated that it is due to endocarditis would you code the complication code (996.02) and then add a second code for the endocarditis (424.90)? Please advise.

BH

Comments

  • dsmith12h@aol.comdsmith12h@aol.com
    edited May 2016
    I have a question. If a patient comes in with a complication of a heart valve
    ie dehiscence) and it is stated that it is due to endocarditis would you code
    he complication code (996.02) and then add a second code for the endocarditis
    424.90)? Please advise.
  • dsmith12h@aol.comdsmith12h@aol.com
    edited May 2016
    It would seem that you would code first the complication and add an additional code for the endocarditis. If the complication is "dehiscence of the valve" --the dehiscence may be already included in the the 996.02 (Mechanical complication due to heart valve prosthesis). It appears by the documentation provided that the complication (dehiscence) was caused by endocarditis, so I think an additional code would be added for that.

    I looked for a coding clinic and for a coding guideline but can't find one.

    Would be interested in hearing from some of the CCS out there on this one.
  • evanspx@sutterhealth.orgevanspx@sutterhealth.org
    Multiple coding would be used to fully describe both the dehisence as well as the specific type of any existing endocarditis concomittant with the dehesince - (I would look for a 'better' code than the generic code for endocarditis).

    Logic stated in Coding Guidelines as follows: "Multiple codes may be needed for late effects, complication codes and obstetric codes to more fully describe a condition."

    I have a PDF regarding coding of Complications, but can't attach as the file size is too large.

    Paul Evans, RHIA, CCS, CCS-P
  • ssalinasssalinas
    edited May 2016
    This one is kind of tricky in my opinion. You may need more than one
    complication code and the endocarditis code. I can think of 3 possible
    principal diagnoses: 996.02, 996.61. 421.0

    Most times the complication causes the other diagnosis which would make
    the complication the principal diagnosis. In this case the complication
    (dehiscence) may be the result of the other disease process or of
    another complication (infection) of the valve.

    Questions that would help me make a decision: Was the endocarditis the
    result of infection of the valve? Had the endocarditis already been
    treated prior to admission or was it still being treated? Was the
    reason for admission to repair/replace the heart valve?

    Sharon
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