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