Q&A: Other thrombophilia with atrial fibrillation
Q: Should we query for D68.69, Other thrombophilia, for every patient with atrial fibrillation (AF) on a long-term anticoagulant?
A: Coding Clinic, second quarter 2021, p. 8, supports the coding of D68.69, Other thrombophilia. The Coding Clinic specifically states that “Secondary hypercoagulable states are acquired disorders of thrombosis due to complex and multifactorial mechanisms. Patients with AF on chronic anticoagulant therapy may have an increased incidence of acquired hypercoagulable state.” However, a word of caution when sending a query for this condition.
As outlined in the ACDIS/AHIMA Guidelines for Achieving a Compliant Query Practice brief, the clinical indicators must support the question posed in the query. Every patient has a different story, and the clinical indicators will be unique to that patient. It is possible that a patient could have had an episode of AF and converted but was ordered anticoagulation therapy as prophylactic therapy and, as a result, not for the treatment of a coagulation disorder. In short, the clinical context of the ordered treatment needs to be taken into consideration.
An additional consideration when sending a query for this condition is linking the two conditions: AF and the secondary hypercoagulable state. The question posed in Coding Clinic, second quarter 2021, p. 8, included the need to link these two conditions. The advice given in the Clinic is that it is not necessary to specifically link the AF and the secondary hypercoagulable state; however, that is for coding purposes. For denials management, my advice—when sending a query to appropriately capture the secondary hypercoagulable state—would be to link the two conditions in the multiple choice responses when appropriate. Capturing this diagnosis accurately also opens the door for provider education. In the words of a former colleague, “do you want to learn how not to get a query?” With an approach like that, your providers may be all ears!
Editor’s note: Kim Conner BSN, RN, CCDS, CCDS-O is an HCPro educator. She may be contacted at Kimberly.conner@hcpro.com.