Condition to qualify in the list of chronic diseases

Chronic diseases are always difficult to code for a medical coder. Sometimes even highly experienced coders are unable to code a list of chronic diseases. So, you are not alone there who has the problem with chronic diseases. The problem with these chronic disease is the criteria to consider them chronic condition. The documentation saying “on going” “from past 6 months” or “over the last several years” etc are not always enough to consider them a part of list of chronic diseases. So, finally you have to still analyze a lot to understand the exact criteria to qualify for a chronic disease.

Common occurring list of chronic diseases.

Migraines

Migraine is occurred more in women than in men. Several attacks occur monthly around 4 to 5 times for a person suffering from migraine. The attack last for 4 hours to three days depending upon the severity of the disease. In diagnostic coding migraine is classified in different type

1. Hemiplegic migraine

   Hemiplegic Migraine are very serious. The patient experience an extreme pain and can lead to paralysis. Symptoms usually last for 5 to 60 minutes.

2. Chronic migraine

   these occurs more than 15 days for at least 3 months. These can really considered in list of chronic diseases.

3. Persistent Migraine

   these migraine occurs daily, three times at least and can last more than three months. Hence, these are really persistent migraine.

   So, now we can judge how to find out he migraine in the list of chronic diseases.

   Now, if the documentation by the physician states that the patient is having ongoing migraines for several years due to tension. So, these type of headache occurs due to the tension hence are not considered as chronic.

   Headache occurring more than 15 days per month for at least 3 months are qualified for chronic migraine. So, even if the documentation mention the phrase “past several years” about headache doesn’t makes the disease to list in chronic diseases.

Otitis Media

This is a very painful disorder. The symptoms are the formation of pus in ear, redness of eardrum and fever. Acute Otitis is more common type of infection.

The criteria to qualify for a list of chronic diseases.

Acute

Persistent

Recurrent

Chronic

So, if a patient is treated for otitis media one month ago and come for follow-up visit. He suffered a similar episode one year ago.

So, based of these information, the patient is considered as persistent otitis media, not chronic.

Sinusitis

This is an inflammation of sinuses. Inflammation occurs due to infection from bacteria, viruses or fungus.

Acute sinusitis is considered for less than four weeks, sub-acute for four to 12 weeks and chronic sinusitis is considered for more than 12 weeks. Chronic sinusitis can be with or without acute exacerbation. When there is only 4 to 5 acute episodes per year it is recurrent acute.

Chronic sinusitis lasts more than 4 weeks and at least more than 4 episodes per year.

Now, you should be able to qualify a disease in the list of chronic diseases. For any suggestion or question please feel free to comment.

R