Resolved Excludes 1 moved to Excludes 2... R57.0

[JenniferC_265]

While reviewing I46 Cardiac arrest I see under it that R57.0 cardiogenic shock moved from an Excludes 1 to now an Excludes 2. First I am wondering why they made the change then secondly wondering how often dose this kind move happen.

 

[Lori]

On October, 1, 2020 the CDC changes the Excludes1 note to Excludes2 note per below.

I46 Cardiac arrest
Excludes2: cardiogenic shock (R57.0)
I46.2 Cardiac arrest due to underlying cardiac condition
Code first underlying cardiac condition
I46.8 Cardiac arrest due to other underlying condition
Code first underlying condition
I46.9 Cardiac arrest, cause unspecified

AHA will most likely be addressing this in the future in an issue in Coding Clinic. Excludes2 notes are defined as “Not included here.” An excludes2 note indicates that the condition excluded is not part of the condition represented by the code, but a patient may have both conditions at the same time. When an Excludes2 note appears under a code, it is acceptable to use both the code and the excluded code together, when appropriate. That being said, if cardiac shock is due to something other than what caused the cardiac arrest, both can be coded. However if cardiac shock leads to cardiac arrest, what is the coder to do? My interpretation is that there would not be a excludes2 note at all at this code if both codes were ALWAYS allowed to be reported together. There simply would not be a need for an excludes note. However the fact that there is now an Excludes2 note, and cardiogenic shock is a symptom code, it is unclear if the CDC did this to allow both to be reported when they are related to the same cause. My thought is they would not be reported together if the cardiogenic shock is documented as leading to cardiac arrest. In that case you would only report the definitive code, the cardiac arrest. However, AHA may come out later and state you can code both. We don’t know yet. For the record, HIA is going to resubmit a case to see if both cardiogenic shock and cardiac arrest are both coded or not when documented. For the time being I think it best to follow the usual guidelines that if the cardiogenic shock leads to cardiac arrest due to the same cause, that the coder would only report the cardiac arrest code. The cardiogenic shock code is still a “symptom” code that is not usually reported if the underlying cause is stated. If the cardiogenic shock leads to cardiac arrest, then it makes sense that only the cardiac arrest code would be reported. This tip will be updated when we get more information from AHA.

Cardiac Arrest and Cardiac Shock

In the past, there had been an Excludes1 note at I46.- Cardiac arrest that excluded R57.0, Cardiac shock. HIA had also received a letter from AHA on a case in the past that had stated that only I46.- Cardiac arrest would be coded if both were documented.

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