Saturday, March 11, 2017

CHF and Pulmonary Embolism Example

Summary of ICD-10-CM Impacts 
Clinical Documentation
 • ICD-10-CM has a combination code for heart disease due to hypertension.
 • Document the acuity (i.e., chronic, acute, acute on chronic) and type (i.e. systolic, diastolic or both) of heart failure, as there are discrete ICD-10-CM codes for each type. 
• ICD-10-CM separates the etiology and acuity of respiratory failure so it is important to document if respiratory failure is with hypoxia or hypercapnia, if present. 
• DVT has laterality of processes for left versus right. 
• Management of chronic conditions such as hypertension or heart failure should be described in the record. When heart disease is documented “as due to” hypertension it is coded to a combination category in ICD-10-CM. 
• Pleural effusion has no laterality codes. 
• Deep Vein Thrombosis (DVT) includes laterality codes to specify left vs. right.

Coding
ICD-9-CM Diagnosis Codes
995.29 Unspecified adverse effect of other drug, medicinal and biological substance 
E934.2 Therapeutic use of medication 
415.19 Acute PE 
453.40 DVT 
511.9 Pleural Effusion 
518.81 Respiratory failure, acute 
402.91 Hypertensive heart disease 
428.32 LV failure, chronic, diastolic 
416.8 Hypertension, pulmonary artery

ICD-10-CM Diagnosis Codes
T45.515A adverse effect of anticoagulants, initial encounter N/A 
I26.99 Other pulmonary embolism without acute cor pulmonale 
I82.401 Acute embolism and thrombosis of unspecified deep veins of right lower extremity 
J91.8 Pleural effusion in other conditions classified elsewhere 
J96.01 Acute respiratory failure with hypoxia 
I11.0 Hypertensive heart disease with heart failure 
I50.31 Acute diastolic (congestive) heart failure 
I27.2 Other secondary pulmonary hypertension

Other Impacts 
Note: There is nothing in the documentation that says that there was an error in the prescription for Coumadin or that the patient took it incorrectly. If the prescription was correctly prescribed and correctly administered/taken then it would be an adverse effect.

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