Effective Coding Under MS-DRGs - American Health Information ...

Effective Coding Under MS-DRGs
Notes/Comments/Questions
Systolic/Diastolic Heart Failure
due to Aortic and Mitral Valve Disease
• 398.91 – Rheumatic Heart Failure is a CC;
• ICD-9-CM does not allow 428.xx codes serving as a MCC
• Coding Clinic, 2nd Quarter, 2000, page 16-17
• Stipulate that a coder is NOT to make an assumption that
congestive heart failure is rheumatic in nature when a
physician documents valvular disease, including one listed in
the subchapter 393-398 (397.0 – Diseases of the tricuspid
valve).
• Unless ICD-9-CM directs the coder to assign the code for
rheumatic congestive heart failure (which is not required under
396.x) or the physician states the condition is rheumatic, it is
inappropriate to assign a code for rheumatic congestive heart
failure.
• Coding Clinic, 3rd Quarter, 2006, page 7 appears to support
this as well.
Bottom Line – Unless the physician explicitly documents that
the patient has rheumatic heart disease, use 428.xx 37
Pericarditis
• All pericarditis
codes are now CCs
• 423.3 – cardiac
tamponade - a CC
• Consider acute
right diastolic
failure (MCC) in
this circumstance
38
AHIMA 2008 Audio Seminar Series 19
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