Hi everyone! It's been a while since I've posted anything--I had an unexpected "vacation" from work.
While I was away, the AHA's Coding Clinic was busy clarifying ICD-10 coding for us. There were many situations clarified in Q1 of 2016, but a couple of them warrant blog posts.
Heart failure coding has been a challenge for quite some time--with coders and physicians going bck and forth. The physicians telling us that the patient has heart failure, the coders telling the physcians that it doesn't say that in the chart!
Earlier Coding Clinic guidance (Q1 2014) indicated that the coder could not assume diastolic heart failure, systolic heart failure or combined diastolic/systolic heart failure when the physician documented heart failure with reduced ejection fraction (HFrEF) or heart failure with preserved ejection fraction (HFpEF). Thanks to input from the American College of Cardiology, these contemporary terms for heart failure have been now been accepted by Coding Clinic.
Going forward, when the provider has documented HFpEF, HFrEF, or other similar terms noted above, the coder may interpret these as "diastolic heart failure" or "systolic heart failure," respectively, or a combination of both if the provider has documented it, and assign the appropriate ICD-10-CM codes based on these definitions.
Just as an FYI--we've posted new information to HCC University. The 2016 Risk Score Calculator is online, there's an updated document with all of the ICD-10 codes by HCC and the updated Companion Guides for encounter data submission. Stay tuned for exciting HCC U news in the very near future!
Finally, remember, when you have coding questions, you can contact us at Coding@scanhealthplan.com.