Coding Overactive Bladder as Chronic Condition with Rotator Cuff repair

mgrimaldi

Contributor
Messages
12
Best answers
0
I have a question pertaining to Outpatient Surgery done in a facility setting. Patient has Rotator Cuff surgery repair, but has a chronic condition of overactive bladder that they take medications for, PRIOR to coming to the facility for surgery. They are discharged same day and never need to be administered medications while onsite. Provider never references overactive bladder in their documentation, however the fact patient is on Detrol is in their medication list. Our CQA is stating because the patient is on medications and being "treated" for the condition, even though not at this encounter, our coders should be coding this. I'm trying to see if others feel this is appropriate. Thoughts?
 

thomas7331

True Blue
Messages
2,286
Best answers
5
I would not have coded it, as per the guidelines, if there was no documentation that the condition coexisted AND required or affected patient care, treatment or management at the encounter. From your description of the record, it does not sound like the documentation met this definition. Having said that, different provider organizations sometimes do have internal and unique guidelines based on their own payer and reporting requirements and may use different criteria from what is written in the official coding publications. Your management and CQA team should provide their employed coders with clear and written policies as to how they interpret the guidelines, or wish to diverge from the guidelines, so that coder will have an understanding about what their expectations are and can code accordingly. If they aren't communicating that, then a coder can hardly be blamed for using their own interpretation of the published guidelines.
 
Messages
121
Location
Greater Orlando
Best answers
0
I would not have coded it, as per the guidelines, if there was no documentation that the condition coexisted AND required or affected patient care, treatment or management at the encounter. From your description of the record, it does not sound like the documentation met this definition. Having said that, different provider organizations sometimes do have internal and unique guidelines based on their own payer and reporting requirements and may use different criteria from what is written in the official coding publications. Your management and CQA team should provide their employed coders with clear and written policies as to how they interpret the guidelines, or wish to diverge from the guidelines, so that coder will have an understanding about what their expectations are and can code accordingly. If they aren't communicating that, then a coder can hardly be blamed for using their own interpretation of the published guidelines.
Well said Thomas! In a perfect world the coders would receive this information BEFORE they start coding for any health system.
 
Top