This is the IMPACT Registry December 2022 case scenario where we will review sequence number 3231, rheumatic heart disease, and sequence number 3235, seizure disorder. A 10-year-old female presents to the emergency department for a one-week history of fevers, worsening respiratory effort, nausea and vomiting, and decreased appetite, secondary to a sore throat, per her parents. The patient is lethargic, tachycardic, tachypneic, diaphoretic, and a heart murmur is noted. An ECG is obtained that shows sinus tachycardia with left atrial and left ventricular hypertrophy. A quick bedside echocardiogram is obtained in the ED that reveals questionable mitral aortic disease, mitral regurgitation, with a recommendation for a complete, comprehensive transthoracic echocardiogram. The patient is admitted to the facility with a diagnosis of fever of unknown origins, LV dysfunction, and heart failure. The TEE is performed, which shows severe mitral valve incompetence, left ventricular dilation with the preserved ejection fraction, and the patient is taken to the cath lab for further evaluation. Because of the severity of the patient's condition, mitral valve replacement surgery is recommended following a differential diagnosis of worsening heart failure secondary to rheumatic heart disease. During the mitral valve replacement surgery, the patient experiences repeated seizures that is controlled by midazolam and diazepam with a post-operative diagnosis of anesthesia-induced epileptic seizure. Our question is, how is sequence number 3231, rheumatic heart disease, and sequence 3235, seizure disorder, coded in the given scenario? Number one, no to both rheumatic heart disease and seizure disorder. Number two, yes to both rheumatic heart disease and seizure disorder. Number three, no to rheumatic heart disease and yes to seizure disorder. Or number four, yes to rheumatic heart disease and no to seizure disorder. Please take a few moments to review the documentation and the question before making your final determination. And the answer is, number one, no to both sequence 3231 and sequence 3235. The target value of any occurrence between birth and arrival is not met for sequence number 3231, rheumatic heart disease. The patient had no prior history of rheumatic heart disease prior to arrival. Sequence number 3235, seizure disorder, seeks to capture when the patient has a history of a seizure disorder, unprovoked seizures considered from natural causes. Seizures that are caused by anesthesia as a side effect or a spike in body temperature would not qualify as a seizure disorder. Thank you for reviewing the IMPACT Registry Monthly Case Scenario for December of 2022, where we reviewed sequence number 3231, rheumatic heart disease, and sequence number 3235, seizure disorder.

fever

heart failure

rheumatic heart disease

seizures

coding question