Here is a case that is a great example of why a physician reviewing a chart may see things differently than a coder.

This patient with rheumatoid arthritis had pericarditis w/effusion due to rheumatoid carditis.* The coder never made the connection that there is a specific code for cardiac manifestations of rheumatoid arthritis, likely because he/she didn't really understand that RA is a systemic inflammatory/autoimmune process not just affecting joints. Also, one needs to discriminate between rheumatic pericarditis* and rheumatoid pericarditis.

Second, this is a great example of why it's important to look at the Alphabetic index and not just use the 3M encoder to identify an appropriate code. The Alphabetic index specifically directs RA w/pericarditis to the combination code M0530 with the direction "see" not "see also" leaving no question as to how this should be coded. Following the 3M encoder alone, without knowing there is a specific code for rheumatoid pericarditis, doesn't get you to the correct code.”

Alphabetic index:

Arthritis-->rheumatoid-->with pericarditis - See Rheumatoid, carditis (rheumatoid heart disease w/rheumatoid arthritis of unsp sites M0530)

Pericarditis-->rheumatoid - See Rheumatoid, carditis (rheumatoid heart disease w/rheumatoid arthritis of unsp sites M0530)

* Clarification re: the association of post streptococcal rheumatic fever and pericarditis.
Rheumatic fever Pericarditis in those with rheumatic fever occurs more commonly in lower socioeconomic groups and in children, often accompanying endocarditis and myocarditis, with a worse prognosis. Consider rheumatic fever as an etiology in any child with pericarditis. However, this disease is not a demonstrated cause of constrictive pericarditis. In adults, pericarditis may not occur with myocardial or valvular involvement, and it is associated with a better prognosis. The pericarditis usually appears 7-10 days after the onset of fever and arthritis.

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