Coding, Classification & Reimbursement

1.  CHF caused by severe aortic stenosis

Posted 06-08-2017 10:59

Good morning!

Does anyone have info re selection of principal dx when a pt is admitted with CHF due to severe aortic stenosis? They did do an echo to check on the known stenosis. The pt is end stage and now refuses transfer to a facility that could do valve repair or replacement, our facility does not do them. She is treated for the chf of course and then requests dc to Hospice. It was a 7 day stay and CDI is wanting to go with AS as principal, the coders however feel the reason for the admit was the chf. I am finding very little info to support the argument.

Thanks!

 

Ellen Douglas, RHIT,CCS

 


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2.  RE: CHF caused by severe aortic stenosis

Posted 06-09-2017 11:36
Dear Ellen,

I understand why the coder would code CHF as the PDx. The documentation says "CHF due to severe aortic stenosis" which means that CHF is the cause for admission. I am not understanding why CDI is saying otherwise. According to what you posted it seems that the CHF is treated more aggressively the the AS which would push CHF as the PDx again. I agree with your coder and would follow her lead.

Jodi Miller, RHIT, CCS 


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Jodi Miller, RHIT, CCS
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3.  RE: CHF caused by severe aortic stenosis

Posted 06-10-2017 13:18
Hello!

In situations like this, I reference Coding Clinic, 2nd qtr 1990, page 19.  The advice is in reference to CHF due to congestive/dilated cardiomyopathy.  "In most cases treatment revolves around the management of the congestive heart failure (salt restriction, diuretics, and other drugs) and in those instances the heart failure, 428.0 or 428.1, is the principal diagnosis, with cardiomyopathy, 425.4, assigned as an additional diagnosis."  I believe this response is synonymous with CHF due to known AS.

Note the response states "In most cases".  If the etiology of the CHF was not known at the time of admission and testing was conducted to determine the etiology determines a newly diagnosed aortic stenosis, I would sequence AS before CHF.

I am not aware of any subsequent, superseding advice published after that cited.


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Lawrence Barr
President
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4.  RE: CHF caused by severe aortic stenosis

Posted 06-11-2017 17:34

Yes, I'm familiar with that CC and there isn't anything specific re AS that supercedes that I can find either, appreciate the input Lawrence.

 

Ellen Douglas, RHIT,CCS

 


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5.  RE: CHF caused by severe aortic stenosis

Posted 06-11-2017 22:26
Because the severe aortic stenosis is causing the reason for her admit, which is to decrease the s/s of CHF, I don't think you have a choice but to code it as SA...I know it doesn't make sense but the stenosis is making her ill

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Ann Moore
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6.  RE: CHF caused by severe aortic stenosis

Posted 06-12-2017 09:11

You also need to review the treatment the patient had..and the focus of that treatment.  If the focus of the treatment was for CHF..even if the cause of the CHF was the AS..then the CHF would be pdx.  If, let's say, the patient had a valve replacement also along with the treatment for CHF, then the AS would be pdx.

 

Sharon Hekimian, RHIT CCS                                                                 

HIM Coder

PH #  781-453-5215

HOME OFFICE  # 617-312-9205

FAX # 781-453-5783 ATTN: SHARON

 






7.  RE: CHF caused by severe aortic stenosis

Posted 06-12-2017 17:50
I agree with Sharon, you have to look at the focus of treatment. Even though the AS caused the CHF, it is the CHF that actually brought the patient in and is the main focus of treatment, if no treatment was rendered towards the AS.

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Sandra Price
Certified Coding Specialist
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8.  RE: CHF caused by severe aortic stenosis

Posted 06-11-2017 23:07
In my personal opinion based on the information provided the PDX would be the CHF. It sounds like the focus of care was on elevating symptoms of the CHF and not treating the AS. It sounds like the patient was in Acute CHF exacerbation and the AS is a chronic worsening and is not the focus of medical management. The ECHO evaluates both conditions as well.

Lawrence Barr's coding clinic example also points to the logic behind why the AS would not be the PDX. The AS is the underlying physiological cause of the CHF but the CHF is what is being managed here. So without direct intervention on the AS such as surgery I would not go with the aortic stenosis as the PDX in a case where medical management was directed at elevating the symptoms of the CHF. 

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Daniel Rowden CCDS, CDIP, CCS, CPC, COC, CPCO, CPMA, CIC
Senior Consultant
AHIMA Approved ICD-10-CM/PCS Trainer
Engage Community Facilitator
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9.  RE: CHF caused by severe aortic stenosis

Posted 06-12-2017 06:52

Thanks everyone for your input. If we consider that even tho they did the echo to look at the valves (resources) it still was only diagnostic work up, the therapeutic treatment was directed at the chf. If we had the capability and had directly treated the valve then the AS would qualify as principal.

 

Ellen Douglas, RHIT,CCS

 


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