For this, you may actually have to review the ECG readings. However, going by the clinical definition (you may want to run it by your physician champion), if the rate is highly variable and goes into the 120s and 130s I think you have enough justification for a query for paroxysmal. The coder certainly cannot code Afib with RVR to paroxysmal. Pneumonia has been determined, but not the specific type)." Pg 18: "When sufficient clinical information isn’t known orĪvailable about a particular health condition to assign a more specific code, it isĪcceptable to report the appropriate “unspecified” code (e.g., a diagnosis of Medical record is insufficient to assign a more specific code." Separate subentries exist in the Alphabetic Index at the same indentation level,Ĭode both and sequence the acute (subacute) code first."Ĭodes titled “unspecified” are for use when the information in the If the same condition is described as both acute (subacute) and chronic, and Those guidelines are always REQUIRED reading for my CDS for just this type of a reason. This would however be superceded by the aforementioned guideline that if i a condition is classified as both acute and chronic and there is no combo code available in ICD 10, the coder is to code both conditions and sequence the acute version first. The nearest thing to "acute on chronic" as an indexed entry would be "other" as it is a named condition not separately classified. Also the coder really isn't allowed to select "unspecified" when it is in fact specified in the record.that is in the coding conventions and definitions of ICD 10 that coders are required to learn. It shouldn't be to hard to find the reference as it is right in the official coding guidelines, it is mentioned throughout various coding clinics, it's in the AHIMA coding handbook etc. Always code ICD 10 codes to the highest level of specificity available. If you are struggling with the coders desire to use Chronic instead of unspecified that is a basic rule of coding: Coding 101: Never use an unspecified form of a diagnosis if a more specific form of the diagnosis is available. Is there a reason why you WANT it to be unspecified in particular? I don't see a reason to do that but I am interested. There isn't any justification here for trying to get to persistent afib that i can see however as the diagnosis is already established as being chronic and although ICD 10 doesn't list them as excludes 1s, the clinical definitions make them appear mutually exclusive. Under that view you could have chronic afib and paroxysmal afib on the same record. That is the suggested coding for situations where there is no combo code. One other point, i have never actually tried this but it may be possible according to the general code guidelines to report both the chronic and acute forms of the disease. If the rate is below 150bpm you may be stuck with unspecified, although we used to also call the RVR paroxysmal afib if it had a variable rate and went up above 130 frequently, that won't matter much because Paroxysmal gets no credit under the IPPS. I am a bit more conservative when i teach and have been saying around 170bpm but it appears that number has been lowered. If the rate is above 150bpm you can reclassify (and query) for a diagnosis of SVT in accordance with clinical truth. One thing to always look for in these situations is what was the rate.
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