History vs aftercare code

kcarterkcarter
in Home Care Coding General
When a home health agency gets a referral for a diagnosis that is resolved but not necessarily with surgery (c.diff, pneumonia, UTI, etc) what are you using for the primary diagnosis? Often times it is therapy heavy for weakness, etc but coding guidelines indicate not to code a symptom (weakness) when the cause (infection, sepsis, etc) is known. I have typically used a history code as primary as the nurse will often be needed to educate on s/sx and prevention of recurrence. I have recently had it questioned if a history code can or should be listed as primary. I don't see anything in the coding guidelines/conventions other than under aftercare. I do see Z51.89 other specified aftercare. Should this be primary and the history z code second?
Thanks in advance!

Comments

  • Nancy.Wolverton@kindred.comNancy.Wolverton@kindred.com
    edited April 2017
    Hi Karisha.
    This may be arguable by some, but to me, if I see a patient suffering from unusual extreme weakness with a bout of pneumonia that has completed their course of antibiotics, who says their condition is now resolved? Antibiotic course completion does not mean resolution of the acute condition at that moment if one truly understands pharmacology. My understanding of pneumonia is that some take a month to recover back to their baseline. Why would one not use pneumonia as a primary diagnosis? Same for UTI. If a person is not back to their baseline, then are they truly in a "resolved" status? I do not consider not using UTI and pneumonia, etc just because the antibiotics are completed.
    Food for thought.

    Nancy Wolverton RN, CCM, HCS-D
    Kindred at Home
    Little Rock, Arkansas
    501-508-8526
    Nancy.Wolverton@kindred.com
  • andrea.smith4@kindred.comandrea.smith4@kindred.com
    edited April 2017
    Karisha,

    I agree with Nancy..as long as the assessing clinician clearly documents that symptoms remain and associates them with the disease process. Without that association, the documentation of symptoms only could be related to almost anything and not necessarily the condition that should be addressed (PNA, UTI). If the patient is no longer being actively treated (antibiotics, etc.) and there are no symptoms specified as associated with the condition in the assessment, I would feel the need to get more information from the clinician and/or the physician before coding nonspecifically.

    Andrea Michelle Smith, BSN, RN, COS-C, BCHH-C
    Utilization Review Specialist
    Kindred at Home
  • andrea.smith4@kindred.comandrea.smith4@kindred.com
    edited April 2017
    Yes, agreed. I assumed from the initial scenario that the diagnosis was already verified by the physician but assumed by the clinican/coder as "resolved" for some reason (commonly, the cessation of antibiotics). I suppose that my point was that if the diagnosis was verified by the physician it can be coded, of course. However, if the assessment documentation does not support the diagnosis (with symptoms associated with the disease process) and there is no record of some type of active treatment, the claim may be denied despite the verified/coded disease.

    Andrea Michelle Smith, BSN, RN, COS-C, BCHH-C
    Utilization Review Specialist
    Kindred at Home
  • Nancy.Wolverton@kindred.comNancy.Wolverton@kindred.com
    edited April 2017
    Excellent topic of discussion ladies!
    Looks like the experts have spoken.

    Nancy Wolverton RN, CCM, HCS-D-10
    Utilization Review Specialist
    Kindred at Home
    Little Rock, Arkansas
    501-508-8526 (o)
    501-690-2027 (c)
    Nancy.Wolverton@kindred.com
  • kcarterkcarter
    Thank you all for your input. The situation that specifically brought up the question was c.diff treated during an inpatient stay at a hospital followed by rehab at a SNF then referral to homecare due to weakness which developed with the c.diff. But thinking about the larger scope of "active" vs "history of" was what spurred the question here. I appreciate the input!
  • Nancy.Wolverton@kindred.comNancy.Wolverton@kindred.com
    edited April 2017
    THAT would be history of..

    Nancy Wolverton RN, CCM, HCS-D-10
    Utilization Review Specialist
    Kindred at Home
    Little Rock, Arkansas
    501-508-8526 (o)
    501-690-2027 (c)
    Nancy.Wolverton@kindred.com
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