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CDI Education

CDI Education. Cirrhosis. 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

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CDI Education

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  1. CDI Education Cirrhosis

  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

  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. 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 537.83 • Acute and subacute necrosis of liver 570 • Hepatic encephalopathy 572.2 • Hepatorenal syndrome 572.4

  5. Hepatic Encephalopathy • Also, coded as a viral hepatitis with coma • Lab abnormalities mayinclude 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

  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

  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)

  8. Common Cirrhosis CCs • Malignant neoplasm of liver, secondary 197.7 • Malnutrition of mild, moderate, or unspecified degree • Other pancytopenia 284.19 • Acquired coagulation factor deficiency 286.7 • Esophageal varices without mention of bleeding 456.1

  9. Common Cirrhosis CCs cont. • Other specified forms of effusion, except tuberculous 511.89 • Portal hypertension 572.3 • Other ascites 789.59 • Other injury to liver without mention of open wound into cavity 864.09 • Complications of transplanted liver 996.82

  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.

  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

  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 

  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)

  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.

  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.

  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 557.1. If it is located in the stomach, it is coded 537.89. • characterized by painless bleeding, which may be mild to massive in amount. • Signs range from occult blood in stools to iron deficiency anemia.

  17. Questions/Comments Anita Worley, RN, BSN Clinical Documentation Liaison Phone: 317-963-5996 aworley@iuhealth.org

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