Many times, I advise against listing a chronic condition as primary unless there is an exacerbation or strong ability to show why it is the leading reason for home care. There are also multiple medical edits that flag certain diagnoses as primary after multiple episodes.
Can you safely code HTN or CHF or another chronic disease primary after multiple episodes? Yes, of course, if your documentation can support your choice.
Let’s say you have a patient with severe HTN. Her primary physician made conservative changes during the first two certification periods, and those changes did not get the HTN under control. She started seeing a cardiologist, who made several medication changes, and the HTN is finally starting to be controlled. Because her blood pressure isn’t entirely stable, she still requires teaching and monitoring.
She has a couple of chronic conditions that are controlled, but none of them involve teaching and monitoring. Medical edits such as these don’t just review the code choice. Medical reviewers are looking for skilled care, e.g. does the condition have the potential for fluctuation and thus qualify for skilled observation and assessment?
In the scenario above, you absolutely put HTN first; you are using your nursing skills to teach and monitor. Your coding may still get caught in an edit, but your documentation will prevail.
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