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Tip: Understand clinical indicators of CHF before querying physicians

CDI Strategies, July 8, 2010

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Congestive heart failure (CHF) is one example of a condition for which coders and CDI specialists should understand clinical indicators before querying physicians, says Lynne Spryszak, RN, CCDS, CPC-A, a CDI educator at HCPro, Inc., in Marblehead, MA.

Be on the lookout for these specific clues to provide clinical support for a CHF query, says Spryszak:

• An echocardiogram that shows an ejection fraction (EF) of less than 40%, which is indicative of systolic heart failure, or an EF of greater than 50%, which generally indicates diastolic heart failure.
• An echocardiogram that shows LVH, accompanied with documentation of CHF, supports a query for chronic diastolic failure. Look for evidence of decreasing EF and usage of home heart failure medications.
• Increasing doses of diuretics (e.g., physician order of “Lasix 40 IVP now” or “Increase Lasix to BID”). These orders may indicate treatment of an acute or acute-on-chronic episode of heart failure.
• Physician orders that reference cardiology consults, an echocardiogram, or a heart failure standing order set.
• Other indicators, such as a CHF teaching form, CORE measures documentation form, or a nursing assessment that includes jugular venous distension, moist breath sounds, shortness of breath, or labored breathing.

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