Medical Coding Basics — Cardiology (Part 1)

Medical Coding Basics — Cardiology (Part 1)

November 1, 2019 1 By Jose Scott


Alicia: Q: [Medical Coding Basics – Cardiology]
I am having trouble putting it all together! Reading a question and figuring out what to
do in cardio issues. Can you go over cardio? A: What I decided to do was take a couple
cases and these are real cases redacted with people that have cardio issues. Just show
you how to abstract, what to look for when you’re going to be coding a case with somebody
in cardiology. These may not be just cardiology, they could be a practice, but they actually
are cardiology cases. The very first one is she’s coming in for
her yearly checkup. And as I peruse this encounter, I tend to always go to the bottom and go up
from the bottom because when you’re doing risk adjustment stuff, part of that is an
auditing aspect, you have to make sure the signatures are all valid, and so on and so
forth. What I’ll do is I’ll come down here and
I want to know what the assessment is, the assessment is the diagnosis. Sometimes they’ll
say diagnosis, sometimes it will say assessment. I know this, he is assessing that this patient
has right renal artery hyperplasia, hypertension and palpitations. Then, I can look here real
quick and say, “Yeah, sure enough, there’s a plan of care that addresses all of that,”
so those are three codes that I know I’m going to be looking at.
I go back up and let’s see what’s going on with the patient, see if there’s anything
else that we can capture. Right here on the first one I see left ventricular diastolic
dysfunction secondary to hypertension. OK. Then, we have fibromuscular hyperplasia of
the right renal artery per arteriogram – we knew we were going to code that – hypertension
and mild hypercholesterolemia. Then I look at the medications. When you’re
doing risk adjustment and HCC coding, you have to draw a line; so I see something that’s
going to be a diagnosis, I want to see if there’s a medication, that’s the easiest
way to draw a line. But on top of that, you’re going to go down here and say, “OK, this
is the history that they’re taking, blood pressure is mentioned. The patient has palpitations;
that’s mentioned.” These are words that leap off the page at me. Also, we see that
they took the vital signs, which is probably always going to happen. Again, that tells
you that the person has hypertension, or you have a backup that this is being addressed. Then, when I go here, I’m going to look
at all of these and this is where you’re going to see a lot of no, no, no stuff; but
if this is a cardiology patient, then there’s probably going to be something here that’s
addressed. So, everything is normal except right here they’ve got trace ankle edema
and people that have cardiac issues often have swelling in the ankles, edema. That right
there is a red flag that we have cardiac issues going on. There are other reasons to have
edema but cardiac is the big one. Then, I get down here and I say, “OK, I’m
not seeing anything else.” Then, confirming right renal artery hyperplasia, hypertension,
and palpitations. Those are the ones that I’m going to code first. I went ahead and put this out. This visit
was going to get a 99214 or that’s what it did get. The hyperplasia of the renal artery
is 447.3, but I figure a lot of you didn’t know what hyperplasia of the renal artery
was, so I pulled that definition and it’s really when the cells on the inside of the
heart they’re kind of going crazy, they’re abnormal and they’re overgrowing. The heart
is a really interesting tool, a muscle, and you go messing with any part of that perfectly-shaped
and perfectly-formed heart, then you could have problems. Palpitations, definitely have palpitations,
785.1. And then hypertensive heart disease; benign; without heart failure is 402.10. Now,
you might ask, what about the hypercholesterolemia? But,if you noticed, he doesn’t ever address
that, and you don’t code off a problem list. It has to be addressed, it has to be partially
the reason why they’re there and is one of the reasons that you’re coding, I would
say regular coding. If this was for risk adjustment, I could code
that. A lot of people won’t let you code off a problem list, but he’s on Crestor,
so I know he’s actively being treated, and a lot of them will actually date the date
that they’re getting the refill prescription. Again, that’s addressed; but otherwise,
it’s not addressed anywhere else here and it’s not going to be coded for that reason.
It’s not addressed down here in the plan either.