Q: DVT Prophylaxis – I’m a medical coder
for a hospital. The providers often use diagnosis code “DVT Prophylaxis.” I can’t seem
to find this dx code. Please help. A: I broke it all down for us. First, let’s
talk about what’s DVT stand for? It’s Deep Vein Thrombosis and prophylaxis is preventive medicine; so think of it that way.
Then, the other things you need to know about – and I guess I didn’t make that big,
I’m sorry – Category 2 Codes are therapeutic, preventive or other interventions. What we’re
going to be looking at is 4070F. This is a Deep Vein Thrombosis (DVT), prophylaxis received
by end of hospital day 2. I kind of built not really a scenario but as if this is what
you’re going to see in your inpatient chart. Again, this deals with inpatient specifically.
I think is what that said, I may be getting confused. What’s the rationale about that?
Was this an inpatient one, Laureen? Laureen: Yes, it’s a medical coder for a
hospital… Alicia: Hospital – Okay, yeah. I knew there
was one that was inpatient. For the physician-based coders, you guys, this may look a little bit
different: Patients on bed rest are at high risk for DVTs. To prevent them, it’s important
for your patients who have suffered a stroke or an intracranial hemorrhage especially if
they have decreased mobility. The intent of this measure is to assure that adequate DVT
prophylaxis is received for either diagnosis. Then, they’ve got the clinical recommendations
are: the appropriate type of prophylaxis differs by diagnosis, anticoagulants are generally
contraindicated in patients with intracranial hemorrhage. These patients are still at risk
for DVT so they should receive prophylaxis with mechanical devices. Low-dose subcutaneous
heparin may be initiated on the second day after onset of the hemorrhage.
So, ultimately, this thrombosis – what you want to break it down, it’s a clot. It’s
a clot in the vein deep down in the tissues and it can be very problematic. It often happens
with people that are having surgery or have poor circulation or sick blood – if you
want to say un-medically what it is. People who go up in planes, you know when the pressure
changes. There are lots of reasons that you might need treatment for a DVT.
On the next page, I tried to break down the codes a little bit: Patients who were administered
Deep Vein Thrombosis (DVT) prophylaxis by the end of hospital day two.
Definitions (DVT Prophylaxis): Can include Low Molecular Weight Heparin (LMWH), Low-Dose
Unfractionated Heparin (LDUH), low-dose subcutaneous heparin, or intermittent pneumatic compression
devices. Now, first other thing, if you don’t know,
heparin is a blood thinner. Heparin doesn’t come on a pill. I think you can only get it
by injection, can’t you? I think so. Laureen: Yeah.
Alicia: So, you don’t just go get something to thin your blood, even though there is over-the-counter
stuff, you got to be careful. That does thin your blood a little bit. Also, treatments
are these pneumatic compression devices. So, if you ever go visit somebody in the hospital
or if you’re in the hospital and you see that they put this, like, plastic tube things
on somebody’s leg or both their legs and they’re connected to this little pump, like,
you’re going to pump up one of those inflatable beds and you’ll hear them puff.
What they’re doing is, they’re literally pushing against the skin. They’re keeping
like a pulse in the skin so that it helps promote and it constrict the tissue so that
the blood flows better. This is often stuff that you’ll see with people who have had
surgery. That’s another reason why, after surgeries they get you up and they start moving
you and walking you right away. Laureen: Yeah. Uh-huh!
Alicia: Of course, Laureen as an OT, can probably really give you more indications and stuff
than I can. Day Two – It’s going to end at 11:59 pm
on the second day of hospitalization, day one is day patient was admitted. Numerator
Quality-Data Coding Options for Reporting. Satisfactorily: DVT prophylaxis received.
Your CPT II code is 4070F – DVT prophylaxis received by end of hospital day 2, OR, DVT
prophylaxis not received for medical or patient reasons. Maybe that’s because the patient
checked themselves out of the hospital. You append the modifier (1P or 2P) to CPT Category
II code 4070F to report documented circumstances that appropriately exclude patients from the
denominator – meaning, that they signed themselves out of the hospital, they’re
tired to be in there. 4070F with 1P: Documentation of medical reason(s) for not administering
DVT Prophylaxis by end of hospital day 2. Examples: Patient is ambulatory – well,
you wouldn’t have to do it if the patient is moving around, then you don’t need to
use those pneumatic devices and stuff. Patient expired during inpatient stay – oh, that’s
bad, but again, no reason to treat. Patient already on warfarin (which is a blood
thinner) or another anticoagulant, or other medical reason(s). You’re not going to give
them heparin, which is a massiveblood thinner to somebody that’s already on an anticoagulant,
like, warfarin. 4070F with 2P: Documentation of patient reason(s)
for not administering DVT Prophylaxis by end of hospital day 2. Example: patient left against
medical advice – and again, you’d think why would they do that? But it does happen.
Or, other patient reason(s) – and again, there could be reasons where people might
not want something, a specific procedure done for a specific reason. Or, DVT Prophylaxis
not received, reason not otherwise specified. But, that all has to be documented.
Append a reporting modifier (8P) to the scenario to report circumstances when the action described
in the numerator is not performed and the reason is not otherwise specified – which
I would think that would be frowned upon. 4070F with 8P: Deep Vein Thrombosis (DVT)
prophylaxis was not received by end of hospital day 2, reason not otherwise specified.
Now, if you don’t know what these codes look like, this Category II codes, they are
in your manual and those modifiers are also described in your manual; so you just look
up the Category II codes, and it’s all right there with the guidelines right in front of
it. And you know what, we’ll probably do some future slides on this because we’ll
eventually be getting more involved with the inpatient coding. Isn’t that right, Laureen?
Laureen: Yeah. Alicia: She just went and took the CIC beta
test. Laureen: Shhh, don’t tell people.
Alicia: Sorry. Laureen: Then, I’m going to have to tell
them if I got a “Dear John” letter. Alicia: Just so you know, it’s a beta test.
Laureen: Really, what Alicia just shared with you guys, is what’s called PQRS coding.
Alicia: Yes Laureen: Which I think is really funny that
she went into all of these procedure-type codes when the question was asking her what
the diagnosis is, and she’s like the diagnosis queen, she loves diagnosis.
Alicia: Sorry! Laureen: That’s OK. No. This is good information.
But just so that you know, these are not diagnosis codes, these are Category II codes and we’ll
go over the diagnosis part maybe next time. But what I was looking when she was talking
because I thought it would be good for you to see is what PQRS measures are. Now, the
only reason I know much about it is because when I worked for CodeRyte, which is a computer-assisted
coding company, was bought by 3M, CAC coding, we would have to get the engine to be able
to remind the coders about these codes. These are not your typical – what was done, put
a code down, to get paid for it – this program was voluntary and when you volunteer to do
the program and you report this code, it’s your way of proving that you’re doing quality
care. And the only way to do it is by putting these codes on and certain modifiers that
say you would have done it, but you couldn’t because of this situation, so that’s what
all of that’s about. This is on the CMS.gov website. Just type
in PQRS and it will come up. Pick the link for (dot)gov and this is where you can learn
more about it. As far as board-exam-type questions, if you’re yet to be certified, they don’t
really go into PQRS too much. It’s more about… but the ones that are temporary and
they haven’t found a permanent home in the Level I codes, that’s something different.
These are the codes that are used for this quality measures. That’s PQRS.
Alicia: The CMS.gov website, you can find some amazing stuff on there. If you’re out
needing to look for information, that’s the place to go.
Laureen: I thought this was a good time to show my trick. I show every call now because
everyone loved it. Alicia: They do.
Laureen: CMS can be a little difficult sometimes to navigate.
Alicia: Because you got to get the right term. If you don’t get the right term, you can’t
find. Laureen: If you know, you are looking for
something on a particular site; this is what we do, guys, so get ready for this. I’m
teaching you how to fish. So, PQRS is our keyword and now you do “site colon (site:),”
and you can put codingcertification.org, AAPC.com or CMS.gov. Pick whatever site you want to
hone your Google search to and I’m going to type in CMS.gov and all of the searches
are only of the CMS site. It’s a simple little thing. You can do this right in your
Google search bar. I’m not sure if it works with Yahoo and the other ones, but I know
it works for Google. So these are all the pages that you can find on CMS. Let’s see
what we have… And I do this all the time. When someone asks
a question on our forum or an email and I know we’ve answered it, I know we’ve covered
it in the webinar, I come here and I put the keyword and I do codingcertification.org.
And we have talked about PQRS apparently quite extensively, so you could go click on different
blog articles that some of our blog writers have done; so, a little tip. By the way, speaking
of blog writers, we do have a call for blog writers out. If you go to the main site, codingcertification.org,
and I think it’s under blog. Yes, something logical. If you want to go to the blog itself,
go to CCO blog, but if you want to go to “call for blog writers” if you are talented in
writing and you want to help your fellow coders out, your fellow billers, your fellow physician
practice managers, send us a blog. You can put your name on it, your credentials, and
if you have a site of your own, you could put a link to it, come here and give us your
name. We have a couple of people that have submitted
articles and are under review right now. What credentials you have, you can copy and paste
your article in here or you can email it to us.
Alicia: And I would like to add, too, if you’re new at coding, it might be interesting to
offer a blog article from that perspective. Don’t think just because you haven’t been
a coder for ten years or something like that, that you’re not qualified to write this.
Time management tips, how to deal with stress – all that stuff would be excellent topics.
So, please, if you’re interested, that’s kind of fun. You get to give back.
Laureen: Yeah, definitely.