Transcript 264928

A Clinical Review of the CC/MCC List
William E. Haik, M.D., F.C.C.P.
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DRG Complication/Comorbidity References:
Guidelines for Reporting Other (Additional)
Diagnoses
UHDDS #11 B defines “Other Diagnoses” as “all conditions that coexist at the time of admission,
that develop subsequently, or that affect the treatment receives and/or length of stay. Diagnoses
that relate to an earlier episode which have no bearing on the current hospital stay are to be
excluded.”
General Rule
For reporting purposes the definition for “other diagnoses” is interpreted as additional conditions
that affect patient care in terms of requiring the following:
•Clinical evaluation; or
•Therapeutic treatment; or
•Diagnostic procedures; or
•Extended length of hospital stay; or
•Increased nursing care and/or monitoring; or
•Has implications for future health care needs.
NOTE: The last general rule, “ has implications for future health care
needs,” applies to newborn coding only.
•AHA’s Coding Clinic for ICD-9-CM, Second Quarter 1990, pages 12-16.
•AHA’s Coding Clinic for ICD-9-CM, Third Quarter 2007, page 13.
•AHA’s Coding Clinic for ICD-9-CM, Fourth Quarter, annually.
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Complications/Comorbid Conditions
Clinical Groupings
• Cardiovascular
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Acute myocardial ischemia without MI
Angina, unstable, decubitus, Prinzmetal
Atrial flutter
Block – complete, AV, Mobitz II, trifascicular, BBBB
CAD of bypass graft
Cardiomyopathy (except ischemic)
CHF – left heart failure, systolic or diastolic (chronic or unspecified)
Dressler’s syndrome (post MI syndrome)
Endocarditis (some types, not acute)
Hypertension, accelerated or malignant
Hypertensive encephalopathy
Pericarditis (most types)
Tachycardia – paroxysmal supraventricular/ventricular
Thrombosis/embolism of artery or vein
Thrombosis/embolism of coronary artery stent/graft
Thrombophlebitis
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COMPLICATION AND COMORBIDITY (CC) LIST
FY2011
The intent of this alphabetical list of complications and comorbidities is to include most of the "CCs" in a form that is useful to doctors
and nurse reviewers. Terms are cross-referenced to promote easy retrieval. The “x” is used to alert the reviewer that the code is
incomplete and requires further investigation into the coding book.
ICD-9
CODE
DESCRIPTION
HELPFUL INFORMATION
Anemia
285.1
Acute blood loss
Angina
413.0
Decubitus
413.0
Nocturnal
413.1
Prinzmetal
Unstable, pre-infarction, crescendo,
progressive, accelerated, initial (new onset),
A.C.S.
411.1
Query M.D. “Can ACS with increased troponin level be
further specified as to myocardial ischemia versus
infarction?”
493.xx
Asthma (all types) with acute exacerbation or
status
In patients admitted with pneumonia, check for SoluMedrol/prednisone administration as additional Rx directed
toward the asthma
518.0
Atelectasis
Not just an isolated x-ray finding
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COMPLICATION AND COMORBIDITY (CC) LIST FY2011
ICD-9
CODE
790.7
V85.x
DESCRIPTION
Bacteremia
HELPFUL INFORMATION
Synonymous term: positive blood culture
1. May be reported based solely on the documentation
of clinicians who are not the patient’s provider such as
nurses and dieticians. However, associated conditions
(such as the obesity) must be documented by the
Body Mass Index derangements (BMI < 19 or > physician.
40)
Reference: AHA’s Coding Clinic for ICD-9-CM, 4th Qtr.
2008, page 191 & 2nd Qtr. 2010, page 15
2. Not excluded as CC with obesity-hypoventilation
syndrome as the PDx (unlike morbid obesity)
799.4
Cachexia
“Cachexic” as a descriptor in the H&P exam may be
reported if it is treated (as with dietary supplement, Ensure)
Reference: AHA’s Coding Clinic for ICD-9-CM, 3rd
Quarter, 2006, pages 14 and 15.
1. Query M.D. “LV dysfunction” in patient with ejection
fraction <40%
425.x
Cardiomyopathy (excludes ischemic)
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2. Excluded as a CC with CHF, NOS as PDx, but not
with specific types of heart failure
COMPLICATION AND COMORBIDITY (CC) LIST FY2011
ICD-9
CODE
***
DESCRIPTION
HELPFUL INFORMATION
Colitis
Infectious (not viral or NOS)
Check for bacterial etiology even if unspecified type
491.21
COPD, acute exacerbation
Review for possible coequal PDx with pneumonia
Reference: AHA’s Coding Clinic for ICD-9-CM, 1st Qtr.,
2010, page 12
790.01
Drop in hematocrit
May not report if anemia is documented in the medical
record
292.81
Drug-induced delirium
Query M.D.: “confusion” or “sundowners” secondary to
post-op pain meds
530.12
Esophagitis
Acute
428.x2
Heart failure
Chronic systolic and/or diastolic
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See clinical reference
Systolic/Diastolic Heart Failure
• Systolic heart failure relates to the inability of the ventricle to contract
normally; therefore, eject sufficient blood resulting in a reduced cardiac
output. An echocardiogram is helpful as it may reveal impairment in the
ventricular wall systolic contraction with a reduced cardiac ejection fraction
of < 40%. The most common cause of chronic systolic heart failure is
ischemic heart disease or idiopathic cardiomyopathy.
• Diastolic heart failure results from an inability of the ventricle to relax and
fill normally because the ventricle wall is stiff and/or hypertrophied. EKG
may reveal left ventricular hypertrophy. An echocardiogram may
demonstrate a thickened myocardial ventricular wall, normal contraction
with a normal ejection fraction (> 50%). The most common cause of
diastolic heart failure is hypertension (especially in females) or hypertrophic
cardiomyopathy.
• Note: In many patients with chronic heart failure, abnormalities of both
ventricular contraction and relaxation coexist; therefore, chronic systolic
and diastolic heart failure may occur simultaneously.
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COMPLICATION AND COMORBIDITY (CC) LIST FY2011
ICD-9
CODE
DESCRIPTION
438.2x
Hemiplegia, late-effect of CVA
342.Xx
Hemiplegia/hemiparesis
HELPFUL INFORMATION
Query M.D. “left-sided weakness”
276.1
Hyponatremia
263.9
IBW > 70 < 85;
Malnutrition, unspecified (not moderate or mild) pre-albumin >5<15;
albumin >1.5 < 3.5
278.03
Obesity-hypoventilation syndrome
(Pickwickian syndrome)
Integral to SIADH
1. Suspect in an obese patient (Pickwickian syndrome)
with chronically elevated pCO2 with or without CPAP use
2. Not excluded as CC with morbid obesity as PDx
733.1x
Pathological fracture
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Look for synonymous terms such as osetoporotic,
insufficiency, nontraumatic, spontaneous
COMPLICATION AND COMORBIDITY (CC) LIST FY2011
ICD-9
CODE
DESCRIPTION
HELPFUL INFORMATION
585.X
Renal failure, chronic, Stages IV and V
GFR < 29 and <15, respectively, not on dialysis
518.83
Respiratory failure, chronic
Query M.D.: “O2 dependent”
518.82
Respiratory insufficiency/distress, acute
PO2 >60, < 70 with symptoms & Rx
728.88
Rhabdomyolysis
Increased CPK with normal MB band
295.Xx
Schizophrenia most types, except unspecified
Query M.D.: to specify type such as “chronic” if on
psychotropic drugs and clinically stable
112.0
Thrush
Query M.D.: “sore mouth.” Look for Rx with
Mycostatin, Diflucan, etc.
599.0
Urinary tract infection
Query M.D.: “pyuria on antibiotics”
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Major Complications/Comorbid
Conditions (MCC) Clinical Groupings
• Cardiovascular
– Cardiac arrest (if discharged alive)
– CHF – acute (or acute on chronic); systolic or diastolic
– Cor pulmonale, acute
– Endocarditis/Myocarditis, acute (excluding rheumatic)
– MI, acute
Pericarditis (a few rare types such as due to
Histoplasmosis)
– Shock (cardiogenic or other shock without trauma) (if
discharged alive)
– Ventricular fibrillation (if discharged alive)
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MAJOR COMPLICATION AND COMORBIDITY
(MCC) LIST FY2011
ICD-9
CODE
348.4
DESCRIPTION
HELPFUL INFORMATION
Brain compression/herniation
Do not code 2° to trauma
Cerebral edema
Reference: AHA’s Coding Clinic for ICD-9-CM, 3rd Qtr.,
2009, page 8 (tumor)
Reference: AHA’s Coding Clinic for ICD-9-CM, 1st Qtr.,
2010, page 8 (bleed)
707.23
Decubitus ulcer, Stage III
Full thickness skin loss
707.24
Decubitus ulcer, Stage IV
Skin ulcer with necrosis of soft tissue → bone
End-stage renal disease
Assign in patients with chronic kidney disease requiring
chronic dialysis, regardless of CKD stage
Gastrointestinal Hemmorrhage (linked to
certain underlying GI disorders)
Gastritis, ulcers, diverticular disease, etc.
348.5
585.6
***
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MAJOR COMPLICATION AND COMORBIDITY
(MCC) LIST FY2011
ICD-9 CODE
530.7
DESCRIPTION
Mallory-Weiss syndrome
HELPFUL INFORMATION
Esophageal tear after forceful vomiting, usually
presenting as a UGI bleed
260
Kwashiorkor
IBW < 70%;
pre-albumin < 5;
albumin < 1.5
lymphocytes < 1,500/uL
Protein depletion only
261
Marasmus and severe NOS
Synonymous term: emaciation
262
Severe protein calorie
Malnutrition, severe
780.72,
Quadriplegia/quadriparesis functional,
343.2-344.xx congenital, and acquired)
584.5-584.8
Renal failure, acute with a specific renal lesion
such as ATN, etc.
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Functional quadriplegia (780.72) is defined as the
inability to move 2° to another condition such as
dementia, severe contractures, arthritis, etc.
Reference: AHA’s Coding Clinic for ICD-9-CM, 4th Qtr.,
2008, page 143
FENa > 2%;
urine specific gravity<1.015;
BUN/creatinine ≤ 20:1,
urinalysis – tubular cast