Question

64. A patient was admitted with heart failure within one week of a heart transplant. Due to the timing, the coder thought the heart failure may indicate a transplant rejection. What action(s) should the coding staff take? a. Query the physician. b. Assign the codes for the transplant rejection and the heart failure. c. Assign only the code for the transplant rejection. d. Assign only the code for heart failure.

Answer 1

The coding staff should query the physician if they suspect possible transplant rejection based on sudden heart failure after a heart transplant. Assumptions should not be made while coding medical conditions. The appropriate code can be assigned depending on the physician's diagnosis.

Step-by-step explanation:

In this case, the action that should be taken by the coding staff is to query the physician. While the timing of the heart failure within one week of a heart transplant could potentially indicate transplant rejection, it is not up to coding staff to make this determination. Only a trained medical professional can make this diagnosis. The coding staff should not assign codes for medical conditions based on assumptions. The physician responsible for the patient's care needs to be queried to get an accurate diagnosis. Depending on the physician's response, the coding staff may then assign the appropriate code for heart failure, transplant rejection, or both if both conditions are clinically validated.

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