Autumn time is here, one of my favourite seasons, the oranges, browns and caramel yellows calming our busy days. Well, I think so anyway!
It’s been a few months since my last blog; it’s just been so busy, but I’m back on the blog so to speak.
What I would like to share with you this month is feedback on heart failure (HF) disease register validation and the themes that are common place across general practice.
HF Disease Register Validation
Patients who are on the HF register do not always have a “sub category code”; i.e. Echocardiogram shows left ventricular systolic dysfunction (LVSD).
Patients who are found to have a sub category code in their record are not always found on the HF register, thus without the heart failure – “umbrella” code.
Many patients who have been seen by cardiac rehabilitation teams post myocardial infarction with a transient LVSD finding can be found in the above list, so care should be taken to look for ongoing LVSD dysfunction before adding them to the HF register.
Once the initial validation has been actioned, you may find some patients remain in your search list without a LVSD (i.e. HFrEF) or LVDD (i.e. HFpEF) code.
Don’t panic, as these patients are those with right heart failure, valvular heart failure or restrictive cardiomyopathies.
Another theme I have come across is practice teams may have coded/ticked in a template “HF review done” for those with just with a coronary heart disease diagnosis during their annual review. The problem here is this can lead to an assumption by a clinician that this patient has HF and then repeatedly reviewed as such. Only select HF review recall for those with confirmed heart failure.
Ensure letters from cardiology and echocardiogram reports are coded appropriately as “cardiology letter” and “echocardiography report”.
Echoes can be mistakenly coded as ECG and vice versa.
Another finding has been related to referrals. For example, a referral to an angina clinic can be miscoded as a referral to the heart failure clinic. Once the reference to HF is within the notes it can confuse the clinician.
Be careful to code patients who have been seen by cardiac rehabilitation as such and not the HF team. These minor issues increase the risk of future staff assuming there is an existing heart failure diagnosis.
Those patients who have been placed on the HF register through the use of Left Ventricular Failure (LVF) code should be reviewed on a case-by-case basis.
Several patients have normal echoes with no further episodes of flash LVF and may warrant removing from the register if deemed appropriate.
Coding for normal LV function should be coded as “Echocardiogram shows normal left ventricular function”. Some mistakes have been made using the diagnostic code for the condition and then free texting the word “Normal“ used. Please do not do this.
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