Combination coding of HTN heart disease with CHF and CKD
Please assist with some guidance re: the appropriateness of querying providers for the subsequent ICD-9 combination code of "HTN heart disease with CHF and CKD" 404-. We nurse CDS' as a group feel that such query is appropriate for inpatient admissions directed at the treatment of heart failure due to a diastolic or systolic dysfunction; however, we see it as problematic for patients who are treated for some other cardiac diagnosis. For example, it seems that the patient with a history of hypertension, CKD stage III, ischemic cardiomyopathy, and diabetes who is admitted with malignant hypertension for whom the plan of care includes IV antihypertensives, telemetry, and a 2-D echocardiogram. If we were to query in such case for "hypertensive heart disease," the subsequent DRG would assign to "Heart Failure & Shock," which doesn't seem to accurately describe the clinical picture, patient and/or plan of inpatient care. Consequently, core measures are also effected due to such code assignment leading one to question how even those measures could be accurately extracted during such a visit.
How are other facilities handling queries for this clarification/code when the patient does not have an acute exacerbation of CHF or impairment in systolic/diastolic dysfunction, in regards to HF readmissions and this code assignment?
Thank you,
Carol Canipe RN, BSN, CCDS
Clinical Performance Improvement
704-834-4980
Caromont Health
Gastonia, NC 28053
How are other facilities handling queries for this clarification/code when the patient does not have an acute exacerbation of CHF or impairment in systolic/diastolic dysfunction, in regards to HF readmissions and this code assignment?
Thank you,
Carol Canipe RN, BSN, CCDS
Clinical Performance Improvement
704-834-4980
Caromont Health
Gastonia, NC 28053
Comments
I just reviewed a record in which there is documentation from a physician office which reads
"HCVD c CKD 404.12"
The patient was admitted with acute on chronic right CHF with grade 3 diastolic dysfunction.
Are we allowed to use the 404.91 code or does this require a query to hook the CHF to it?
Charlene
heart failure per se, but if I read this correctly the linkage can be
assumed. But reading the ICD-9-CM manual, you have to make sure that the
chronic kidney disease with stage is coded along with the heart failure.
I'll look forward to see what others say about this as well.
Robert
Robert S. Hodges, BSN, MSN, RN, CCDS
Clinical Documentation Improvement Specialist
Aleda E. Lutz VAMC
Mail Code 136
1500 Weiss Street
Saginaw MI 48602
P: 989-497-2500 x13101
F: 989-321-4912
E: Robert.Hodges2@va.gov
"We are continually faced by great opportunities brilliantly disguised
as insolvable problems." Benjamin Franklin
FROM 2007 Coding Guidelines
Hypertension with Heart Disease
Heart conditions (425.8, 429.0-429.3, 429.8, 429.9) are assigned to a code from category 402 when a causal relationship is stated (due to hypertension) or implied (hypertensive). Use an additional code from category 428 to identify the type of heart failure in those patients with heart failure. More than one code from category 428 may be assigned if the patient has systolic or diastolic failure and congestive heart failure.
The same heart conditions (425.8, 429.0-429.3, 429.8, 429.9) with hypertension, but without a stated casual relationship, are coded separately. Sequence according to the circumstances of the admission/encounter.
3) Hypertensive Chronic Kidney Disease
Assign codes from category 403, Hypertensive chronic kidney disease, when conditions classified to categories 585-587 are present. Unlike hypertension with heart disease, ICD-9-CM presumes a cause-and-effect relationship and classifies chronic kidney disease (CKD) with hypertension as hypertensive chronic kidney
Sharon