Q&A: Echo and type of CHF
Q: Is it appropriate to code the type of congestive heart failure (CHF) based on the echocardiogram (echo) results? Coding Clinic, Third Quarter, 2014, p. 5, discusses the use of imaging reports for increased specificity. It states that it is appropriate to use imaging reports to provide greater specificity of the anatomic site as documented by the physician. Some say this covers coding the type by the echo report, while others say this is not an anatomic site so this does not apply. What are your thoughts on this?
A: Coding Clinic, First Quarter, 2014, tells us we can differentiate the type of heart failure based on the interpretation of heart failure with preserved ejection fraction and heart failure with reduced ejection fraction. This information provides differentiation of the type of heart failure, but it must be documented by an approved provider responsible for hands-on care and assessment of that patient.
I would take the differentiation of the diagnosis of heart failure from an echo report if the echo report interpretation is dictated by a cardiologist who is actually consulting and caring for the patient. But, if the interpretation is just that, perhaps documented by the echo tech or later interpreted by a cardiologist who is not involved in direct patient care, and the provider caring for the patient did not document the type, it cannot be taken for code assignment.
The Coding Clinic you speak to pertaining to obtaining further specification of a diagnosis from imaging refers mainly to the location of the issue, such as a fracture, CVA, or injury. We are able to pull this information to support further specification of an already existing diagnosis code. The action of pulling the information from an echo to further differentiate the type of heart failure is a bit different than determination of location. In my mind, it describes a specific diagnosis, as we would likely address a diastolic heart failure differently than we would a systolic heart failure when planning the care. So, I would not interpret this Coding Clinic to allow for this differentiation. Sadly, we need to continue to query the provider to give us these descriptors.
Editor’s Note: Laurie L. Prescott, RN, MSN, CCDS, CDIP, CRC, AHIMA Approved ICD-10-CM/PCS Trainer, is the CDI Education Director at HCPro in Middleton, Massachusetts. Contact her at lprescott@hcpro.com. For information regarding CDI Boot Camps visit http://hcmarketplace.com/clinical-doc-improvement-boot-camp-1.