# coding chronic conditions



## dmaec (Mar 3, 2009)

if the patient was admitted (inpatient status) for the fracture - and he has those chronic conditions mentioned and takes medication for it... he will continue to get his "chronic conditions" meds while inpatient, therefore "IS" being treated for the conditions.  The conditions are being taken into consideration and treated during his hospital stay...
you'd code them all... if being addressed and treated during that stay.


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## dmaec (Mar 3, 2009)

I'm saying, that I'd code any condition that is treated that affects their care during that stay.  That being said, UNLESS that patient was admitted at a time of day where they had already taken their meds (at home) for their chronic conditions and was then released the next day BEFORE it was time for his medications, I'd find it highly unlikely that any hospital would "not" treat chronic conditions managed by medication during that patients stay.  
and yes, since HTN, and DM affect care and treatment, I'd code them even if that patient was in less than 24 hours and didn't receive meds...


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## dmaec (Mar 3, 2009)

you know, I had my answer all typed out and previewed my post when I realized - what "I'd" do, and that answers you're looking for are two different things.  
I'm pretty sure my answer(s), are not going to satisfy your questions.


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## RebeccaWoodward* (Mar 3, 2009)

Just food for thought.....

The ICD-9 guidelines instruct us to code chronic problems if they have an impact to the current condition or if the chronic condition is currently being treated along with the current chief complaint.

Page 70~

http://www.cdc.gov/nchs/data/icd9/icdguide.pdf

I agree with Donna when she stated..." I'd code any condition that is treated that _affects their care_(emphasis mine) during that stay".


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## RebeccaWoodward* (Mar 3, 2009)

I thought my reference was referring to that...sounds like we're splitting hairs.  I would love for someone else to chime in.


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## maysons1703 (Mar 3, 2009)

In outpatient setting, chronic conditions that are not addressed or assessed should not be picked up. If a pt with HTN presents to the ER for fracture due to a falland the only place that the provider mentions his conditions is in the PFSH, then I would not pick up HTN. I would code the fx, E-code, treatment CPT and E&M. However, if this same HTN pt, was admitted for fx surgery, then I would code HTN, because if you were to look in the flow sheet, and the doctor's orders you will see that they oredered the nurses to give them their medicines. If it is a pathological fx, most defintely, pick up all chronic conditions. Remember, chronic conditions affect the DRG's if inpatient.


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## mholland (Mar 3, 2009)

DONNA'S PERCEPTION IS MORE ACCURATE MAYBE HER WORDING IS WHAT YOU DO NOT QUITE GRASP. In the outpatient ER setting you do code for the chronic conditions regardless if they are treated (as w/meds) as they are present and may affect the patients condition and treatment. HTN and DM would always be coded in the outpatient setting. The staff including the physicians take these chronic conditions into consideration when they are administering a particular patients care. Therefore they are a part of their decision making and coordination of care. 

Hope this clears up any confusion if not I will find the Coding Clinic or AMA CPT assistant article pertaing to this particular subject.

Let me know

Marybeth CPC


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## RebeccaWoodward* (Mar 4, 2009)

I completely agree.


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## maysons1703 (Mar 4, 2009)

So if the provider treats the HTN pt the same as he would a pt w/o HTN (reduce, splint , prescribe vicodin, and submit ortho referral) it is appropriate to pick up the HTN? If so, how, when the management or treatment was not altered b/c of the pt's CC?


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## cgonthier (Oct 25, 2013)

*wound*

I code for the facility side of wound. My question is on chroinic conditions how far back can we code them out? Say a patient is seen in the wound clinic in July and the patient is still being seen 2 months later or longer would you use the chronic conditions from the intial visit? 
thank you,


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