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CDI Education Cirrhosis 4/17/2017.

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Presentation on theme: "CDI Education Cirrhosis 4/17/2017."— Presentation transcript:

1 CDI Education Cirrhosis 4/17/2017

2 Objective: At the end of this presentation, participants should know:
Definition of Cirrhosis Identify and define common MCC’s in Cirrhosis documentation Identify and define common CC’s in Cirrhosis documentation TIPS procedure Coding issues surrounding Cirrhosis 4/17/2017

3 Cirrhosis The liver carries out several necessary functions, including detoxifying harmful substances in your body, cleaning your blood and making vital nutrients Late stage of scarring (fibrosis) of the liver caused by conditions, such as hepatitis and chronic alcohol abuse Occurs in response to damage to your liver The liver damage done by cirrhosis can't be undone. As cirrhosis progresses, more and more scar tissue forms, making it difficult for the liver to function (decompensated cirrhosis). Advanced cirrhosis is life-threatening 4/17/2017

4 Common Cirrhosis MCCs Hepatitis C with coma 070.71
Severe Protein-calorie malnutrition 262 Portal Vein Thrombosis 452 Esophageal varices with bleeding 456.0 Angiodysplasia of bowel and stomach with hemorrhage Acute and subacute necrosis of liver 570 Hepatic encephalopathy 572.2 Hepatorenal syndrome 572.4 4/17/2017

5 Hepatic Encephalopathy
Also, coded as a viral hepatitis with coma Lab abnormalities may include elevated serum ammonia levels Must be associated with an altered mental status Patients my have elevated ammonia levels, but no AMS; therefore, not considered encephalopathic 4/17/2017

6 Acute and subacute necrosis of liver
Development of severe acute liver injury with encephalopathy INR of ≥1.5 in a patient without cirrhosis or preexisting liver disease 4/17/2017

7 Hepatorenal syndrome Diagnosis of exclusion
Diagnosed based upon clinical criteria Chronic or acute hepatic disease with advanced hepatic failure and portal hypertension. A serum creatinine above 1.5 mg/dL that progresses over days to weeks (ie, acute or subacute kidney injury). An often normal urine sediment No or minimal proteinuria (less than 500 mg per day) A very low rate of sodium excretion (ie, urine sodium concentration less than 10 meq/L) Oliguria (not always, especially in acute stage) 4/17/2017

8 Common Cirrhosis CCs Malignant neoplasm of liver, secondary 197.7
Malnutrition of mild, moderate, or unspecified degree Other pancytopenia Acquired coagulation factor deficiency 286.7 Esophageal varices without mention of bleeding 456.1 4/17/2017

9 Common Cirrhosis CCs cont.
Other specified forms of effusion, except tuberculous Portal hypertension 572.3 Other ascites Other injury to liver without mention of open wound into cavity Complications of transplanted liver 4/17/2017

10 Pancytopenia Medical condition in which there is a reduction in the number of red and white blood cells, as well as platelets anemia: hemoglobin < 13.5 g/dL (male) or 12 g/dL (female). leukopenia: total white cell count <4.0 x 109/L. thrombocytopenia: platelet count <150×109/L. 4/17/2017

11 Coagulopathy A condition in which the blood’s ability to coagulate is impaired Can cause prolonged or excessive bleeding INR>1.5 PT>18 seconds PTT>60 seconds 4/17/2017

12 Ascites Defined as the accumulation of fluid in the peritoneal cavity
Most often results from liver cirrhosis Treated with paracentesis to relieve abdominal pressure from ascites diagnose spontaneous bacterial peritonitis and other infections  4/17/2017

13 Transjugular intrahepatic portosystemic shunt (TIPS)
Procedural Code 391 Changes DRG to 405, 406, or 407 An artificial channel within the liver that establishes communication between the inflow portal vein and the outflow hepatic vein. Used to treat portal hypertension (which is often due to liver cirrhosis) To reduce intestinal bleeding, life-threatening esophageal bleeding (esophageal varices) and the buildup of fluid within the abdomen (ascites) 4/17/2017

14 AHA. Coding Clinic. First Quarter 2002 1st Quarter p. 3
Alcoholic Liver Cirrhosis versus Hepatic Encephalopathy When it comes to alcoholic liver cirrhosis versus hepatic encephalopathy, the 2002 first quarter AHA Coding Clinic clearly advises coders to assign hepatic encephalopathy as the principal diagnosis, noting that hepatic encephalopathy is a life-threatening event that may require immediate treatment. Coders should ask themselves whether they could stay home watching TV with alcoholic liver cirrhosis. The answer is probably yes. However, with hepatic encephalopathy doing so would be virtually impossible. 4/17/2017

15 AHA. Coding Clinic, November - December 1985 Page: 14
Bleeding esophageal varices w/Laennec's cirrhosis The Alphabetic Index provides the sequencing direction and directs that the cirrhosis of the liver is to be sequenced first, with the bleeding esophageal varices sequenced in second position. Esophageal varices are a complication of various types of cirrhosis of the liver and, in this instance, the cirrhosis is laennec's. 4/17/2017

16 AHA. Coding Clinic, November - December 1984 Page: 7 to 8
Angiodysplasia of bowel and stomach an arteriovenous malformation, usually of the bowel, is coded If it is located in the stomach, it is coded characterized by painless bleeding, which may be mild to massive in amount. Signs range from occult blood in stools to iron deficiency anemia. 4/17/2017

17 Questions/Comments Anita Worley, RN, BSN
Clinical Documentation Liaison Phone: 4/17/2017

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