Anesthesia and comorbidities

beachgrl62

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On a recent audit in my department I was marked down for having too many DX codes that they felt did not affect anesthesia. If my provider puts the dx in the pre-op evaluation I enter it in the charges. I don't feel that it is up to me to determine if that comorbidity "affects" the anesthesia. I felt it was interesting the auditor felt that smoking, hypothyroidism and DM were not important in the anesthesia process. I have done some research to find documentation that supports adding the comorbidities and not finding anything. Any suggestions?
 

dwaldman

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Smoking F17.200
Hypothyrodism E03.9
Diabetes E11.9

The above diagnoses don't technically fall on the CC list (Complications and Comorbid conditions) that Medicare provides for MS-DRG classifications. When looking at some the codes they have on their CC list, you typically see for example COPD is not considered to fall on the list but COPD with acute exacerbation would be considered to add to the complexity and effect the DRG assignment. I know you referencing something else but I was just pointing out these conditions provided don't qualify as the definition as comorbid conditions from other coding standpoints provided by CMS. Certain medical policies might have conditions that if the patient possesses then it would meet the criteria for the procedure to covered under general anesthesia or other forms.

https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/FY2019-IPPS-Final-Rule-Home-Page.html

Below from Table 6J Complete CC List----you can see for diabetes some types codes they are considering a CC; which is far from simply E11.9
E08.52
Diabetes mellitus due to underlying condition with diabetic peripheral angiopathy with gangrene
E09.52
Drug or chemical induced diabetes mellitus with diabetic peripheral angiopathy with gangrene
E10.52
Type 1 diabetes mellitus with diabetic peripheral angiopathy with gangrene
E11.52
Type 2 diabetes mellitus with diabetic peripheral angiopathy with gangrene
E13.52
Other specified diabetes mellitus with diabetic peripheral angiopathy with gangrene
 
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