traumatic intracranial bleed and brain compression/herniation
I know I was told by one of our coders at one point that the MCC "brain compression" was inherent in the traumatic bleed codes. However, now I can't find that reference anywhere.
Anyone know where it is?
Also, I'm assuming brain herniation is inherent to because ti codes to 348.4. brain compression as well?
Thanks,
Katy
Anyone know where it is?
Also, I'm assuming brain herniation is inherent to because ti codes to 348.4. brain compression as well?
Thanks,
Katy
Comments
occupying space and causing 'midline shift" with neurological
consequences, such as hernia and or diffuse edema of the brain.
Separate codes exist precisely to report the clinically significant
edema and/or hernia of the brain when these are stated as a consequence
of an underlying process. One codes the stroke or neoplasm as the
principal condition with the edema or hernia as a secondary. So, when
these are stated, they should be coded to fully describe the complexity
of the case.
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
Compression
brain 348.4
due to
contusion, brain - see Contusion, brain
injury NEC - see also Hemorrhage, brain, traumatic
laceration, brain - see Laceration, brain
This indicates the code for the injury includes compression of brain when due to injury.
Per the alpha code book, brain herniation and brain edema CAN be coded in addition to the injury code.
However based on the Coding Clinic below, brain compression can be coded in addition to injury code.
Shift and mass effect and brain compression
Coding Clinic, Third Quarter 2011 Page: 11 Effective with discharges: September 23, 2011
Question:
The patient suffered an acute subdural hematoma with shift and mass effect. We have been instructed by a consultant that shift and mass effect are clinically synonymous with brain compression and should be coded as such. Would it be appropriate to assign code 348.4, Compression of brain, based on the provider’s documentation of "mass effect or midline shift"?
Answer:
The coder should not make the assumption that midline shift or mass effect is synonymous with brain compression. The coder should query the provider and if the provider clarifies and documents that the "mass effect" or "midline shift" is brain compression, the coder may then assign a code for the brain compression.
Bottom Line for me - Always go with the code books when there is a descrepancy. I am going to ask CC about this though.
Sharon
Thats what I assumed intially. But, our coders have told me that when the injury is traumatic, they are not supposed to code the compression separately (they do code the edema). They only feel this way aobut the traumatic injury. Not a CVA or tumor.
In the Acdis journal, it states;
"Traumatic cerebral hemorrhage, ICD-9-CM code set 853.xx (other and unspecified intracranial hemorrhage following injury), does include the sub-term "cerebral compression due to injury". Coders should also report a code for the specific injury when possible."
However that only is talking about the 853 codes, not 852.
I guess i'm not exactly sure what the Acdis article is suggesting. When I read it the first time, I read it as confirming what I had been told by our coders. But, is also is saying to code a specific injury, so I'm not sure.
I'm confused. We have a couple coders that had already told me this "rule". We recently got a contract coder, and she says the same.
I really appreciate your input,
Katy
The coding clinic is not referencing traumatic ICH, so as you state, when you drill into brain compression, it codes back out to the ICH and therefore can't be used as a secondary dx. Only with nontraumatic ICH can brain compression be coded separately. That's why I'm always looking at the etiology of any intracranial bleed and querying when it's unclear.
Renee
Linda Renee Brown, RN, CCRN, CCDS
Certified Clinical Documentation Specialist
Banner Good Samaritan Medical Center
This is what I am being told (you are much more eloquent in your explanation!). Do you have a reference to this?
Thanks,
Katy
Do you have access to an encoder? Do a drilldown for brain compression--if you take it to a traumatic etiology, it will loop you back to the brain hemorrhage, without a separate code for the brain compression.
Renee
Linda Renee Brown, RN, CCRN, CCDS
Certified Clinical Documentation Specialist
Banner Good Samaritan Medical Center
as tumor or ICH.
Initially, I did not know you were referring to these processes with
TRAUMA. I would not report anything from the 3XX series if these are
due to trauma as the codes from the 3XX are not use to report trauma.
I don't understand why your coders would chose to code the edema, but
not the hernia in conjunction with the trauma codes.
The codes in 850 - 854 provide specificity regarding the type of
intracranial injury due to trauma. Example: 851.5X is used to report:
Brain stem contusion due to trauma WITH open intracranial wound. You
can review further examples in the Tabular.
Due to this coding convention, I would use 'only' the trauma codes for
traumatic injuries of the brain.
I do code edema and hernia as secondary when these occur with ICH or
stroke.
You further explanations provided clarity to the question.
Paul
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
I do. That was one of the ways the coders told me its not possible to code it. I was just hoping tehre was something written down. But, i trust your judgement! More than anything, just wanted to make sure I'm on the right page here.
So, In your opinion then, if the patient has herniation of the brain, can that be coded? As far as I can tell, the encoder does let me do that. I'm just wondering since it codes out to the "brain compression" code.
Sharon
I am just reading the CC to its last word, and if it doesn't say it, it seems to me then it doesn't include it, particularly given the way brain compression d/t traumatic ICH codes out. ICBW, but we both agree on how it codes out in the alpha & tabular list, and that's why I'm being so literal. I have a sneaking suspicion that when they wrote the response, they weren't even thinking about traumatic ICH.
But I think your plan to ask CC is excellent. Won't it be cool to have a CC in response to your very own question?
Renee
Linda Renee Brown, RN, CCRN, CCDS
Certified Clinical Documentation Specialist
Banner Good Samaritan Medical Center
Hematoma, 6-unspecified, 5-Other, 1-Brain, 6-Subdural, 2-no fx, 3-Other/Unspec, 2-W/O open wound, 1-no unconsciousness, 1-No complication, (ignore E-codes) and come up with 852.21
It comes out the same if you use the book - if you start with hematoma, you have to choose non-traumatic to get to 432.1
The only way I could get to the 432.1 is to start with hemorrhage (instead of hematoma) or choose non-traumatic but the question did not say hemorrhage or non-traumatic. Hemorrhage and hematoma may be used interchangeably but since it did not say it, I did not use it. I know I am probably being way too literal.....
As I said, I am sure you are correct regarding CC's answer. I agree if the etiology of a bleed is not clear, querying is necessary.
You are correct - it is cool to see a response to a question you posed. I always figure there must be a lot of other people out there asking the same question!
Sharon Salinas, CCS
If this is a traumatic injury, code to the trauma section.
The Coding Clinic states in a nutshell that if edema or hernia ARE documented with an intrinsic disease, we may code the edema or hernia. The particular Coding Clinic does not provide any info re: traumatic brain injury.
A coder ALWAYS first determines if the process is traumatic versus a stroke or AVM and then proceeds forward.
AHA Coding Clinicâ for ICD-9-CM, 3Q 2009, Volume 26, Number 3, Page 8
Question:
A patient was admitted through the emergency department (ED) complaining of difficulty exhaling. He also reported experiencing strange smells during the past month. A computed tomography (CT) scan of the brain done in the ED showed a large mass in the right temporal lobe with a mass effect, pressing the right cerebral peduncle and compression of the cavernous sinus on the right side. Subsequent magnetic resonance imaging (MRI) revealed the same findings without surrounding edema. The consulting provider documents most likely slow-growing glioma. The provider's final diagnostic statement indicates newly diagnosed malignant brain tumor. Is it appropriate to assign a code for compression of the cavernous sinus as a secondary diagnosis?
Answer:
Assign code 191.2, Malignant neoplasm of brain, Temporal lobe, only, for slow-growing glioma, since it is the more definitive diagnosis. The cavernous sinus compression was a CT scan and MRI finding. The provider's documentation did not indicate that the brain compression was clinically significant; therefore a code for the compression would not be assigned
Shift and mass effect and brain compression
Coding Clinic, Third Quarter 2011 Page: 11 Effective with discharges: September 23, 2011
Question:
The patient suffered an acute subdural hematoma with shift and mass effect. We have been instructed by a consultant that shift and mass effect are clinically synonymous with brain compression and should be coded as such. Would it be appropriate to assign code 348.4, Compression of brain, based on the provider’s documentation of "mass effect or midline shift"?
Answer:
The coder should not make the assumption that midline shift or mass effect is synonymous with brain compression. The coder should query the provider and if the provider clarifies and documents that the "mass effect" or "midline shift" is brain compression, the coder may then assign a code for the brain compression.
Renee
Linda Renee Brown, RN, CCRN, CCDS
Certified Clinical Documentation Specialist
Banner Good Samaritan Medical Center
Donna Kent, RN, BSN, CCDS
Manager, Clinical Documentation Integrity Program
Clinical Quality and Accreditation
Torrance Memorial Medical Center
ph.:310 784-6884 fax:310 784-6899
donna.kent@tmmc.com
(348.4)
based on the information provided of traumatic SDH with brain
compression and herniation.
I think the confusion previously was over traumatic vs nontraumatic SDH.
If the only info available is SDH (subdural hematoma), it goes to
traumatic.
Sharon
You can not code Cerebral Compression with a traumatic ICH as it is inherent in the traumatic ICH code. BUT if the physcian specifically documents herniation, that would be coded.
Hope I'm right!
Katy