Life Threatening Conditions Fact Sheets

One of the questions we receive most frequently is "Can we submit ______________________ diagnosis in an office setting?"

The answer is:  If the condition is life threatening, and there is no indication that the physician either called 911 or instructed the patient to go to the hospital (even if they refuse), then it is not appropriate to submit a life threatening diagnosis.

We recognize that sometimes patients either go to the doctor's office with a life threatening condition, or one develops while they are there.  However, we expect to see some indication that the physician treated the condition as an emergency.

Most often, physicians document these conditions because they don't realize that they should clearly indicate that it is a "history of" the condition, not a current illness.  In order to help physicians understand appropriate documentation and coding, we've developed  a series of "Life Threatening Conditions Fact Sheets", which you can download from HCC University.  The fact sheets below are available.  If you think others are needed, please send us an email to coding@scanhealthplan.com, and we'll see if we can develop one.

• Sepsis Fact Sheet
• Acute MI Fact Sheet
• Unstable Angina/Acute Coronary Syndrome Fact Sheet
• Acute Respiratory Failure Fact Sheet
• Acute CVA Fact Sheet

We hope you'll use these fact sheets to help educate the physicians in your practice.

If you have questions about the content of these fact sheets, please let us know.