Wiki Acute Vs Chronic Vs Unspecified

[ljones88]

Hi all,
I have scoured the ICD10-CM guidelines and I swore there was an actual "time" definition for acute vs chronic diagnosis codes but I can't find it and I need clarification.

I specifically remember attending coding-related training events where speakers (more then 1 and from various entities) advising that "4 weeks or less" is considered "acute" whereas "over 4 weeks" is considered "chronic".

FOR EXAMPLE: If the physician did not explicitly state in the MR the patient had "acute" otitis media BUT documented that the symptoms started "3 days ago" we could safely code to the "Acute otitis media" vs the "unspecified otitis media" because the doctor is documenting symptoms that occurred less then 4 weeks ago........now I'm questioning this rationale as being false cause I can't find anything to support it in 2019.

 

[Chelle-Lynn]

We go by the rule of thumb that if the provider does not specify acute or chronic we use:

• Acute: sudden onset and/or has limited duration
• Chronic: on-going, usually lasting 6 months or longer. In addition a newly diagnosised illness can be considered chronic prior to the 6 months if there is no expectation of improvement or cure.

If the patient has multiple reoccurring ear infections it may be opportunity to query the provider on if the situation is becoming a chronic condition.

 

[mitchellde]

It has always been my understanding that the provider must be the one to document whether a condition is acute or chronic and there is no rule of thumb for this. even though a condition may be a long term issue it may not be chronic by the providers medical opinion there is so much we just don't know and are not privy to as coders. There are instances when the guidelines tell us what to code for instance pain, they tell us if it is documented as postoperative pain then we default to acute even though the operative procedure could have been moths ago. so unless documented it is unspecified in my opinion.

 

[kdlberg]

It has always been my understanding that the provider must be the one to document whether a condition is acute or chronic and there is no rule of thumb for this.

It is chronic if the provider says it is. If it isn't documented, you can't code for it. Now, if I saw several indicators this might be a chronic condition, I would query the provider (who could do an amendment.)

 

[Munzueta]

I think you are thinking about the timeframe for MI (myocardial infarcts) on Chapter 9 of the ICD-10-CM, which tells you about how to code an MI that has happened within 4 weeks of another one, or if its older than 4 weeks, etc.

There is no specific guideline that says how to code acute or chronic based on time, the main guideline about acute and chronic is, when you have a condition specified as both, acute on chronic, the acute code will go first followed by the chronic code.

Now also, one thing that I've learned in my previous jobs and in trainings, is that we as coders, can not assume. We don't have medicine degree so it is the providers responsibility to specify when a condition is acute or chronic, or both. If not, then your option will be unspecified, because if you decide to go "acute" based on timing, then at that point you are giving a diagnosis to the patient, not the provider.

So be careful with that, unless like Mitchel stated, if there is a guideline telling you what to assume, then follow it, but if not, then a query and provider education will be needed.

If you believe documentation supports acute vs chronic, then make sure to query, I've had seen a lot of scenarios where I think "oh I think the provider is trying to say this" but then I query and the provider came back and said something completely different, that's why they are the ones that have to provide the diagnosis.