Q: If you have an acute exacerbation of chronic right heart failure (CHF) with a preserved ejection fraction (EF) above 55%, can you code it as heart failure (HF) with preserved EF? All the clinical symptoms exemplify right-sided heart failure (e.g., ascites, pronounced neck vein distension, swelling of ankles and feet).
Q: When it comes to conditions not related to hypertension, is it sufficient to attribute the diagnosis to another etiology or does the provider need to specifically document that the congestive heart failure (CHF) is not due to hypertension?
Q: If a patient is admitted for anemia related to a malignancy and is treated only for anemia, the principal diagnosis goes to the malignancy. Could you still code for the malignancy as the principal diagnosis if the patient was treated for other conditions at the same time?
Q: Our team had a recent case that involved a small midline episiotomy which extended to a second-degree laceration which was repaired with 3-0 vicryl rapide sutures. Would we code the episiotomy and repair or just the repair, and why?
Q: At my institution, all of our congestive heart failure exacerbations get at least one chest x-ray. Is that enough “diagnostic testing” to code the secondary condition in accordance to Coding Clinic ?
Q: I can't distinguish between "code first" and "in diseases classified elsewhere.” Both are used with manifestations and both can't be sequenced as principal diagnosis and both need etiology codes, so what is the difference?
Q: We use an electronic system at our hospital, and find it is difficult to query a physician since we all have our own processes. Would you recommend having a set format for a query that is used electronically?
Q: We are currently coding a chart for an acute kidney injury which has the baseline serum creatinine and urine output missing from the chart. Is there something we can do before we have to query the physician?
Q: Can you please help me determine the query opportunities and code assignment/sequencing argument related to a patient who was admitted with pneumonia, congestive heart failure, acute respiratory failure, and encephalopathy?
Q: One of my coworkers thought we needed the phrase “unable to clinically determine” as an option on every multiple-choice query we send. My take on it is that if we have “other” with an option for free text, that would cover us for compliance. Further, I thought it was inappropriate to include this option in some cases, as it may offer an option that is preventing me from obtaining the detail and specificity I need.
Q: I am the coding manager for our inpatient coding department. I am wondering if I should create an audit plan to monitor new coders or difficult diagnosis. If so, is there anything specific I should consider when trying to implement a plan?
Q: If a patient is admitted to the hospital with diabetic ketoacidosis (DKA) and cholelithiasis, and is treated for both, would you code the cholelithiasis as the principal diagnosis because the patient had his or her gallbladder removed?
Q: My hospital’s coding team keeps having trouble distinguishing between J44.0 (chronic obstructive pulmonary disease with acute lower respiratory infection) and J44.1 (chronic obstructive pulmonary disease with [acute] exacerbation. Is there any guidance out there that can help clarify their differences? We would appreciate any help.
Q: I have a question about coding a medically induced coma. For example, how would I report a patient on a Precedex drip for alcohol withdrawal, supported with mechanical ventilation, and intensive nursing care?
