Wiki COVID dx on echoes and EKGs

heartyoga

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Our physician performs ancillary services, reading EKGs and echocardiograms, for the ER.

Our coder went to the AHIMA and CDC websites and pulled out a bunch of info regarding COVID coding. She is a perfectionist and wants to code things by the guidelines.
From what she understood from the website, she has to sequence COVID even if it is not documented in the echo and EKG reports.


E.g. Patient comes to the ER with cough, shortness of breath and EKG results conclude "patient in sinus rhythm". No mention of COVID in documentation.
She feels she has to find the reason why EKG was ordered. She goes back to the ER physician report, reads through it and if it says there patient was tested for COVID she feels she has to wait for the results to confirm and code U07.1 either as primary or secondary.

From what i understood from the AHIMA guideline (correct me if I'm wrong), this is for hospitalists or primary care physicians who have a face to face encounter with confirmed COVID cases and are seeing the patients to treat COVID.

Our physician reading EKGs and echocardiograms truly have no mechanism to document (and code for COVID). I feel she is exerting extra efforts for no gain, for herself, for the patients or for the practice.

I believe she has taken the guidelines out of context.

Please enlighten me.

Thank you.
 
I agree with you on this, as we've discussed before, per guidelines in coding physician services, your primary diagnosis code reported should be that which is "chiefly responsible for the services provided". Additional codes may be reported for conditions that co-exist, but if not documented by your provider as associated with the services performed, could be considered either unnecessary at best or unsupported by documentation at worst.

Just to stress again, guidelines are just that - they are meant to guide, not to dictate, the coding process because every situation is unique in its own way. In the current COVID-19 emergency, there is even more confusion than usual about what is the 'right' way to report the many new situations that we are all facing. As such, it is both recommended and expected that organizations need to make their own decisions about how to interpret the guidelines in order to develop internal processes and guidelines for their coding staff to ensure consistency, accuracy and efficiency in the use of resources, and coders need to defer their organizations on these types of questions. In the event of a disagreement about guidelines, the final decision on how to interpret them is ultimately up to the practice's leadership. Good luck and hope this helps some!
 
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