I tend to agree with Karen. If the acute blood loss anemia isn't treated then it shouldn't be coded. This is a brief excerpt from an article written by Dr. Robert Gold and Dr. William Haik on ABLA due to fractures and GI bleeds.
"It is not uncommon for patients to lose several hundred cc's of blood into a hip or long bone fracture site (unrelated to the surgery), Haik says. "The drop of the hgb/hct won't occur until after the surgery some 12 to 24 hours later as the plasma volume is restored with hydration, etc.," he says. "And therefore, if addressed or treated, then the physician should get credit for the increased hospital use."
With a femur (hip/long bone) fracture, says Gold, a patient may lose up to two units of blood whether the patient goes to the operating room or not. And, as Haik suggests, once the patient receives IV fluids, the hemoglobin level falls whether the patient goes to the operating room or not.
There are two considerations once that drop in hemoglobin happens, Gold says.
- If the drop in hemoglobin never reaches a level that meets the criteria for anemia, do not ask the physician to document anemia due to acute blood loss from the fractured femur, because it's not anemia.
- If the hemoglobin does drop low enough to be called anemia but the physician does not treat the patient for it, do not ask anyone to assign a code for it. In general, do not assign a code for a condition that is not treated or followed as it doesn't meet the UHDDS criteria as a valid secondary diagnosis.
"Sure, ask the physician to document for consistency, but as 'anemia due to acute blood loss from the femur fracture.' Then, if it is treated, code it -if it's not, don't," Gold says.
Similarly, with a GI bleed or extreme menorrhagia or severe hematuria, a person can easily develop anemia due to acute blood loss, Gold says. Here, unless the patient goes to the operating room, there's no concern about "complications of surgery." However, if the patient does go to the operating room (suture ligation of bleeding duodenal ulcer) or has a procedure (embolization of bleeding submucosal leiomyoma), as long as the documentation is provided as "anemia due to acute GI bleed" or "anemia due to acute blood loss from submucosal fibroid," the 285.1 code should be assigned but not the 998.11 code.
"That's because the anemia was not due to any excessive blood loss from the procedure, but from the pathologic condition-and that's not counted as a complication of a procedure anymore," Gold says."
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Arlene Baril, MHA, RHIA, CHC
Senior Director, Provider Coding & Audit Services
Change Healthcare, TES Division
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Original Message:
Sent: 10-10-2018 14:18
From: Karen Karban
Subject: Clinical validation vs reportable criteria
One thing to consider with "acute blood loss anemia"...it might as well be stated as acute blood loss with anemia. I have seen surgeons document this as expected according to the type of surgery and I have also seen surgeons document it based on the amount of blood loss recorded during surgery. Without treatment of the condition, especially in the era of clinical validation, I don't think this winds up being a condition that you can accurately assign a code to. Especially with Orthopedic surgeries, the reality is that those surgeries are bloody, thereby technically meeting the ABLA term but if it does not lengthen the stay and there is no aggressive treatment, I just don't think you can ethically code it.
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Karen M. Karban, RHIT, CDIP, CCS
Sr. Product Manager
Lumeris
Original Message:
Sent: 10-10-2018 13:33
From: Lori Drodge
Subject: Clinical validation vs reportable criteria
Thank you for your reply Donna. This was a short stay in which no labs were done. Wondering what the thought is about coding conditions that are documented without evaluation, monitoring, treatment or length of stay impact.
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Lori Drodge, RHIT, CCS, APPROVED I10 CM/PCS
Original Message:
Sent: 10-10-2018 05:17
From: Donna Nelson
Subject: Clinical validation vs reportable criteria
If the clinician notes "acute blood less anemia" (whether expected or otherwise), it must have been determined by lab results, correct? Thus to me it has met the criteria of evaluated. If blood draws are done on a subsequent day or days to see if the Hct has stabilized or is recovering, it is being monitored.
Post-op patients, especially orthopedic patients, often get initial physical therapy while still in-house. Those with ABLA might not be able to tolerate optimum levels of therapy if their anemia is symptomatic (dizzy, out of breath, sweaty, etc.)
I found that in the past, surgeons avoided documenting ABLA because they feared it would be viewed as a complication. That's when I started seeing the "expected" bit show up.
Just one angle on the matter.
Donna
Original Message------
When "acute blood loss anemia, expected" is documented, should the decision for coders to code this documentation be based on:
- the fact that the provider documented it only
or
- documentation of the condition as well as reportable criteria are met (evaluated, treated, monitored or extended stay)
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Lori Drodge, RHIT, CCS, APPROVED I10 CM/PCS
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