EmailFluid overload with current congestive cardiac failure (CCF)
Publication Date: June 2016
ICD 10 AM Edition: Ninth edition
Query Number: 3089
Can the committee please confirm if both CCF and fluid overload codes can be assigned when both conditions are treated during an episode of care? Retired Coding Matters Volume 7 No 3 under Congestive heart failure advised it is not necessary to code fluid overload in a patient with CHF.
Retired VICC query #2247 refers to the advice above adding 'However if a patient has a history of CCF, it does not mean that they have it now'. Both national and Victorian advice are retired as of 30 June 2013.
Can the committee please advise the correct code assignment for the below scenarios.
Scenario 1
Patient admitted with a principal diagnosis of congestive cardiac failure. The 3rd page of the discharge summary lists fluid overload as a problem initially fluid overloaded on admission diuresed to good effect. IV Frusemide 80 mg TDS initially 20mg oral frusemide on DC. The chest x-ray notes fluid overload and the doctors have written in the notes
Imp: diastolic heart failure. Doctors later note the patient has refractory angina, CCF. On the day before discharge the doctors note HF relax fluid restriction to 2L, Frusemide to 20mg daily.
Scenario 2
Patient admitted with a principal diagnosis of fluid overload secondary to non-compliance with fluid restriction. There is documentation in the clinical notes of CCF on frusemide then later fluid overload IV frusemide. Doctors note Imp: infective exac CCF + fluid intake. Patient is on a 1.5L fluid restriction as well.
Retired VICC query #2247 refers to the advice above adding 'However if a patient has a history of CCF, it does not mean that they have it now'. Both national and Victorian advice are retired as of 30 June 2013.
Can the committee please advise the correct code assignment for the below scenarios.
Scenario 1
Patient admitted with a principal diagnosis of congestive cardiac failure. The 3rd page of the discharge summary lists fluid overload as a problem initially fluid overloaded on admission diuresed to good effect. IV Frusemide 80 mg TDS initially 20mg oral frusemide on DC. The chest x-ray notes fluid overload and the doctors have written in the notes
Imp: diastolic heart failure. Doctors later note the patient has refractory angina, CCF. On the day before discharge the doctors note HF relax fluid restriction to 2L, Frusemide to 20mg daily.
Scenario 2
Patient admitted with a principal diagnosis of fluid overload secondary to non-compliance with fluid restriction. There is documentation in the clinical notes of CCF on frusemide then later fluid overload IV frusemide. Doctors note Imp: infective exac CCF + fluid intake. Patient is on a 1.5L fluid restriction as well.
Response
VICC advises that if the documentation supports that both the fluid overload and the congestive cardiac failure independently meet criteria for coding, a code for both conditions can be assigned. Sequencing of the codes will be in accordance with ACS 0001 Principal diagnosis and ACS 0002 Additional diagnosis.
With respect to scenario 1 VICC considers that only the CCF would be coded because it is the documented principal diagnosis and there is no indication that the fluid overload was treated independently of the CCF.
With respect to scenario 2, VICC considers the fluid overload would be assigned as principal diagnosis as it is the documented principal diagnosis, followed by the code for non-compliance. As the documentation also notes that the patient is on Frusemide for CCF and that the Frusemide was altered, a code for the CCF should be assigned in addition in this case.
With respect to scenario 1 VICC considers that only the CCF would be coded because it is the documented principal diagnosis and there is no indication that the fluid overload was treated independently of the CCF.
With respect to scenario 2, VICC considers the fluid overload would be assigned as principal diagnosis as it is the documented principal diagnosis, followed by the code for non-compliance. As the documentation also notes that the patient is on Frusemide for CCF and that the Frusemide was altered, a code for the CCF should be assigned in addition in this case.
