New Atrial Fibrillation Code

heartyoga

Guru
Messages
124
Location
Cookeville
Best answers
0
It's just been less than 2 weeks of new code book update and we just got our new code book. We saw some patients and provider has documented chronic atrial fibrillation (under the 2019 ICD book). Coder is saying doctor needs to go back to each encounter for the past 2 weeks, starting Oct 1 and clarify whether the chronic afib is permanent or not. She wants to see the word longstanding on the persistent afib or we would get "in trouble" with insurances.

Can someone please clarify what kind of trouble we would be in for coding unspecified chronic afib if that is what the provider documented?
 

thomas7331

True Blue
Messages
2,283
Best answers
5
You will not get into 'trouble', and your coder should absolutely not waste the provider's time with this. There is a remote possibility that some payers may not accept the unspecified diagnosis code, but you can deal with that when and if a denial is received, which I wouldn't expect you will even see. When ICD-10 began, CMS issued the guidance below, which I think states it better than I can. The important point is that it is acceptable and correct to use an unspecified code when that is the best code to support the document and the clinical information available. The doctor should not be asked to needlessly amend their documentation based on this incorrect claim your coder has made. Your doctor's priority is to take care of patients and they should never be required to spend their valuable time on unnecessary administrative tasks.

Question: Will unspecified codes be allowed once ICD-10 flexibilities expire?

Answer: Yes. In ICD-10-CM, unspecified codes have acceptable, even necessary, uses.... While you should report specific diagnosis codes when they are supported by the available medical record documentation and clinical knowledge of the patient’s health condition, in some instances signs/symptoms or unspecified codes are the best choice to accurately reflect the health care encounter. You should code each health care encounter to the level of certainty known for that encounter. When sufficient clinical information is not known or available about a particular health condition to assign a more specific code, it is acceptable to report the appropriate unspecified code (for example, a diagnosis of pneumonia has been determined but the specific type has not been determined).
 

heartyoga

Guru
Messages
124
Location
Cookeville
Best answers
0
Thank you Thomas. You have always been the voice of reason.

I have asked our cardiologist to clarify and he patiently explained that in medical terms, permanent chronic afib means it is a shared decision by both patient and physician(s) that nothing will be done about the afib. He said that may even be detrimental to the patient when patient needs referral down the road to an electrophysiologist or changes his/her mind about her afib.

Thank you again.
 

dmunoz781

Networker
Local Chapter Officer
Messages
30
Best answers
0
Hello,

Im glad you got an answer to your question. Just for reassurance purposes I wanted to add and say that I to agree with Thomas and that the MD should not go back and amend the documentation quite yet and deal with the possible denials as they come.
 
Top