Wiki CHRONIC CONDITION CODING ER VISITS

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mbradford1@twcny.rr.com

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Good afternoon,

Our office is having a discussion on whether or not we should be coding chronic conditions on every ER visit. Some say yes, always code chronic conditions that are still current with the patient regardless of what the ER visit is for. Some say only code the chronic conditions if the conditions are treated in the ER at that time. Some say code the chronic conditions if they are related to the reason the patient is being seen in the ER. Can anyone please verify any and all instances and when chronic conditions can be coded or should be coded on ER visits?


Thank you so much in advance,

Melody
 
Mbradfrod,
I d add chronic conditions (the top 10)or forever disease if related to current injury or illness. Usually the provider should know to list this data. Also think about reason pt is coming to ER visit...run out of meds, lacerated hand, fever, or pt suffering with some type of Cancer or HIV symptoms, urinary problems, auto accident muscle aches STD rash,Etc.
Chronic Conditions CHF, Atrial Fib, Parkinson Ds, CHKD stages, DM, ,COPD, Multiple Scleor, Hemiplegia, Arthritis, HIV or Cancer (noted if current vs past history)
Forever Ds can be Depression, Mental Retardation, Herpes genital, HIV, LUPUS, Autism, Alcoholism or differ Sub Abuses, Sickle Cell,or (T.O.A.D) Transplanted organs, Amputations, Ostomies and Dialysis
I hope helped you somewhat on this topic
Lady T
 
A coder cannot use the problem list, medications, history, etc in this setting. EMRs/EHRs in large organizations (and even small) now have running lists of every problem the patient has ever been seen for in an organization. As a coder, you cannot grab from that and make assumptions and infer what you should code from it. The provider must document the condition at the time of the encounter you are coding for. You still have to look for MEAT (Monitoring)(Evaluating)(Assessing/Address)(Treating). The provider must "connect the dots" and document co-morbid or chronic conditions and how it impacted the treatment at that encounter. There may be an opportunity for more queries in the ED setting. If a coder sees a # of medications related to diabetes, blood pressure, etc. yet there was no mention of any of those or any conditions in the ED note and the patient is presenting with lightheadedness, nausea, vomiting, etc. for example. However, think of maybe a patient coming in with a simple, non-displaced fracture of a finger where the ED splints it and tells them to f/u with ortho. Are they going to monitor, evaluate, assess or treat any of the patients other problems they may have such as high blood pressure, diabetes, or CKD? Maybe, but probably not. They may see that they have those conditions when they come in, but if it did not impact or have anything to do with the ED visit for the simple finger non-displaced fracture. Now, let's say the provider does "connect the dots" and documents the patient is on blood pressure medication, their BP is high, they do an EKG and they also mention the diabetes as it relates to healing because maybe the patient also had a laceration on the hand in a different place at the same time. Then you could code the chronics. It is always going to depend on the documentation at the time of the encounter that day. Not all the old stuff in the entire EMR.

Also, in the ED, there are a lot of times when signs and symptoms are coded and there is no definitive diagnosis at the time they are discharged or escalated to observation or IP admission.

Resource links: https://www.aapc.com/blog/86653-cap...IUk2r-sI_Vc6QMwElG4SVdgxUUHB08TQLaal6BimA8J3Y
https://www.jucm.com/nine-recurring-coding-pitfalls-for-urgent-care-clinicians-to-avoid/ (has to do with urgent care but same concept)
Generally helpful FAQs and links from ACEP:
You just have to go back to the ICD-10 outpatient guidelines.
 
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