Alicia: Q: [Medical Coding Basics - Cardiology] I am having trouble putting it all together!
Reading a question and figuring out what to do in cardio issues.
Can you go over cardio?
A: What I decided to do was take a couple cases and these are real cases redacted with
people that have cardio issues.
Just show you how to abstract, what to look for when you’re going to be coding a case
with somebody in cardiology.
These may not be just cardiology, they could be a practice, but they actually are cardiology
cases.
The very first one is she’s coming in for her yearly checkup.
And as I peruse this encounter, I tend to always go to the bottom and go up from the
bottom because when you’re doing risk adjustment stuff, part of that is an auditing aspect,
you have to make sure the signatures are all valid, and so on and so forth.
What I’ll do is I’ll come down here and I want to know what the assessment is, the
assessment is the diagnosis.
Sometimes they’ll say diagnosis, sometimes it will say assessment.
I know this, he is assessing that this patient has right renal artery hyperplasia, hypertension
and palpitations.
Then, I can look here real quick and say, “Yeah, sure enough, there’s a plan of
care that addresses all of that,” so those are three codes that I know I’m going to
be looking at.
I go back up and let’s see what’s going on with the patient, see if there’s anything
else that we can capture.
Right here on the first one I see left ventricular diastolic dysfunction secondary to hypertension.
OK.
Then, we have fibromuscular hyperplasia of the right renal artery per arteriogram – we
knew we were going to code that – hypertension and mild hypercholesterolemia.
Then I look at the medications.
When you’re doing risk adjustment and HCC coding, you have to draw a line; so I see
something that’s going to be a diagnosis, I want to see if there’s a medication, that’s
the easiest way to draw a line.
But on top of that, you’re going to go down here and say, “OK, this is the history that
they’re taking, blood pressure is mentioned.
The patient has palpitations; that’s mentioned.”
These are words that leap off the page at me.
Also, we see that they took the vital signs, which is probably always going to happen.
Again, that tells you that the person has hypertension, or you have a backup that this
is being addressed.
Then, when I go here, I’m going to look at all of these and this is where you’re
going to see a lot of no, no, no stuff; but if this is a cardiology patient, then there’s
probably going to be something here that’s addressed.
So, everything is normal except right here they’ve got trace ankle edema and people
that have cardiac issues often have swelling in the ankles, edema.
That right there is a red flag that we have cardiac issues going on.
There are other reasons to have edema but cardiac is the big one.
Then, I get down here and I say, “OK, I’m not seeing anything else.”
Then, confirming right renal artery hyperplasia, hypertension, and palpitations.
Those are the ones that I’m going to code first.
I went ahead and put this out.
This visit was going to get a 99214 or that’s what it did get.
The hyperplasia of the renal artery is 447.3, but I figure a lot of you didn’t know what
hyperplasia of the renal artery was, so I pulled that definition and it’s really when
the cells on the inside of the heart they’re kind of going crazy, they’re abnormal and
they’re overgrowing.
The heart is a really interesting tool, a muscle, and you go messing with any part of
that perfectly-shaped and perfectly-formed heart, then you could have problems.
Palpitations, definitely have palpitations, 785.1.
And then hypertensive heart disease; benign; without heart failure is 402.10.
Now, you might ask, what about the hypercholesterolemia?
But,if you noticed, he doesn’t ever address that, and you don’t code off a problem list.
It has to be addressed, it has to be partially the reason why they’re there and is one
of the reasons that you’re coding, I would say regular coding.
If this was for risk adjustment, I could code that.
A lot of people won’t let you code off a problem list, but he’s on Crestor, so I
know he’s actively being treated, and a lot of them will actually date the date that
they’re getting the refill prescription.
Again, that’s addressed; but otherwise, it’s not addressed anywhere else here and
it’s not going to be coded for that reason.
It’s not addressed down here in the plan either.