Medical Coding Ejection Fraction Diagnosis -Video

Q: [Ejection Fraction] What is an ejection fraction? Can I code an ejection fraction of 0% as with occlusion?

A: Now, ejection fraction just happens to be part of a cardiology aspect as well. You have ejection fractions for your gallbladder but you also have ejection fraction as most commonly known for cardiology. It’s pretty exciting. When I saw this question, I looked at and I thought, “OK, what is an ejection fraction?” and first of all, I spelled it wrong when I was thinking of it, I spelled it like injection, you give somebody an injection. But this is actually spelled with an “e” and they’re saying, “Can I code an ejection fraction of 0% as with occlusion?”

Well, let’s talk about what it is. By definition, ejection fraction is a measurement of the percentage of blood leaving your heart each time it contracts. So, picture your heart, you’ve got the two chambers at the top, and you have the two chambers at the bottom. The two chambers at the bottom are called ventricles. You have a right ventricle and a left ventricle. It just so happens that the left ventricle is the one that has the most power, fills up with the most blood. So, they can check both of them, but usually they start with the left ventricle.

What happens is when that contracts, it pushes out the blood, so then when it opens back up, the blood pushes into that ventricle. You have a certain capacity that that ventricle, that chamber can hold; and as it contracts and pushes that blood up pass the valve into the atrium, the ejection fraction is the amount of blood that pushes that gets out of the chamber, but some of that blood is left in the ventricle. So, let’s say that you’re never going to get 100% of the blood to go up into the atrium, there will be a little bit left, so they take how much went up there, let’s say, 85%; so then that’s how they measure that. It’s not what’s left in the ventricle, it’s how much got pushed through. There are guidelines that tell you how much is normal; so it’s measured.

Since the left ventricle (LV) is the main one that is the one measured. An LV ejection fraction of 55% or higher is for the most part considered normal. That’s what you’re looking at. So, 55% of the blood goes from the ventricle and whooshes up into the atrium, goes through that valve. If you’re 50% -55%, it might be considered “borderline.” But there are some studies and different physicians consider certain things 50, 51; 50 might not be borderline for them.

Medical Coding Ejection Fraction Diagnosis -Video

We’re going to see what are the reasons for an ejection fraction to be low, it might not be what you thought. It’s weakness of the heart so they might have dilated cardiomyopathy (again, on this term, if you don’t know what cardiomyopathy means, you need to go Google it. You need to go look it up). Maybe a former MI (meaning they’d had a heart attack).

Just a little tidbit in ICD-9, it was like six week’s out, I think, they will be considered an old MI. In ICD-10, it’s only four weeks; so there’s a big change there.

It might be a heart valve disease. As that goes through, the valve isn’t working properly, so that ejection of blood up into the atrium may not be a good amount that it should be. And they might just have uncontrolled hypertension, they may have had it for a long time. Those are all things that could give you low ejection fraction.

So, how did they figure this out? What did they do? Well, they can do several tests. They do echocardiograms, they do cardiac catheterizations, they may do an MRI, they do CT scans, and they do a nuclear medicine scan. All of those are ways that they can tell and see how much fluid and track that, that blood that’s getting up into the atrium from the left ventricle. And they can do the right ventricle too, but usually what they do is they focus on the left ventricle because that’s kind of the powerhouse of the heart.

Now, what I want to state, to answer the question that was given: occlusion has to be documented. So, occlusion isn’t necessary, if we’ve gotten zero percent ejection fraction, that doesn’t necessarily mean there’s an occlusion. I would say the answer to your question is no, it has to state that… it has to be documented for you to call it an occlusion because there are several other reasons why it could be that low.

This is an image of what they’re doing. There’s the left ventricle, you can always tell if you’re looking at the back or the front of the heart by the apex is looking; so if that apex, the little V part of the heart is facing this way, we’re looking at the front of the heart. If it’s facing off to the other side, we’re looking at the back of the heart. FYI. There we’ve got the percentage of blood ejected up into the atrium and that’s the left ventricle.

Right there at the last, I added: Normal – 50-65%, Below Normal – 36-49%. Anything below 35% is just real bad news; so what happens? It usually means they get, like, afib; and so then, you can treat that. But if you have a low ejection fraction, they’re absolutely going to run more tests to find out what’s going on and you’ll probably, they can give you a pacemaker maybe, but you results in afib medication and stuff could be given.

Most of this information I got was from the Mayo Clinic and there’s the website: www.mayoclinic.org/ejection-fraction/expert. I love the Mayo Clinic, lots of good stuff there.

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