acute/chronic and acute on chronic

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in CDI Talk Archive
Does anyone know if there is information in a document or coding clinic that explains why a physician needs to document acute, chronic, acute on chronic?
Thanks

Patti Stewart RN, BSN
Clinical Documentation Specialist
Mercy Medical Center
1301-15th Ave West.
Williston, ND 58801
701-774-7400 ext. 7049

Comments

  • sharon.colesharon.cole
    edited May 2016
    There are several things that when coded require specification of acute, chronic, etc. Look up CHF, you will see that to code specificity, you need acute, chronic, etc. Besides which, if you are using CHF as your principal for example, it looks bad to be admitted for unspecified CHF. Would make an auditor ask why exactly that person needed to be in the hospital if the CHF isn't acute. Hope that makes sense.

    Sharon Cole, RN, CCDS
    Case Management
    254.751.4256
    srcole@phn-waco.org
  • dvitalone1dvitalone1
    edited May 2016
    Also pulmonary emboli, copd, resp failure, renal failure, etc......
  • evanspx@sutterhealth.orgevanspx@sutterhealth.org
    edited May 2016
    Yes: Coding Clinic has stated several times the physician 'must' state
    if a condition is 'acute' in order for the acute component to be coded
    - the rationale cited is that only 'explicit' documentation may be used
    for reporting purposes.



    (So, even if a pt with a CHF is admitted with prominent JVD, ICM of
    15%, abnormal lung exam and film, and out or range BNP treated with
    aggressive diuresis, one may not coded acute systolic CHF unless this is
    clearly stated).



    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
  • ssalinasssalinas
    edited May 2016
    There is no code for acute, chronic or acute/chronic CHF. There is only
    428.0. Systolic and diastolic heart failure have those designations as
    well as unspecified. From a coding standpoint, CHF is not an inherent
    component of systolic or diastolic heart failure and 2 codes are
    required to fully describe the conditions when systolic +/or diastolic
    heart failure (428.2x-428.4x) and congestive heart failure (428.0) are
    present.

    I don't know of a Coding Clinic or coding guideline that specifically
    addresses the need for specification except to say that only a physician
    or other caregiver who is legally responsible for establishing the dx
    can make the determination if a condition is acute or chronic or both.
    Without that specificity, you will end up with a lot of unspecified
    codes or incorrect codes. Bronchitis will be 490 instead of 466.0 for
    acute. COPD will be 496 (not a CC/MCC) instead of 49121 or 49122 (CCs).
    You will end up with acute respiratory failure (MCC) by default when the
    correct dx might be chronic respiratory failure (CC).

    Regardless of what side of the fence your program is on re goals of CDI
    (accuracy of SOI/ROM or accurate/increased reimbursement), the
    specificity makes a difference.
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