Anemia and Diverticulitis

s0lace

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I need help with the principal diagnosis for an inpatient chart.

The patient presented from the nursing home to evaluate the anemia. Anemia was documented all throughout the progress notes as possibly due to acute blood loss. Blood transfusions were done as well as several diagnostic exams. An abscess was found in the abdominal ultrasound. EGD was also done which showed diverticulitis. The abscess was related to diverticulitis but not the blood loss, which was subsequently drained during the admission.

I'm not sure what principal diagnosis to use.
 

mitchellde

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The anemia is the primary diagnosis as it is still the reason for the inpatient stay . The abscess is an incidental finding that does not explain the primary diagnosis of the anemia.
 

s0lace

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Thank you Debra. That's actually what I chose. My auditor stated "Patient admitted w/ anemia, however, thrust of care from day 2 to DC was the patients' diverticulitis w/ abscess. Treatments included drainage, IV antibiotics and EGD."

I'm not sure how to explain myself. I understand that we chose the condition which was the focus of care for the admission if they both meet the criteria for Principal diagnosis. (Like when the patient came in with anemia and abdominal pain.) The H&P only mentions the anemia and the acute renal failure. After study, they still weren't able to find out what's causing the acute blood loss anemia.
 
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mitchellde

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If the cause of the anemia was not found and was not associated with the abscess, then I don't think the providers would have just abandoned that diagnosis in favor of treating the newly discovered abscess. If they were still giving blood and checking the CBC then the anemia was still the focus. This is what you need to look for. The abscess was A focus but did it become THE focus and subsequently the reason for the encounter? Since the abscess and the anemia have no correlation with each other and the purpose of the admission was the symptomatic anemia which was being treated and investigated, then I do not see how you can change the reason for the hospital admission mid stream.
 

s0lace

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If the cause of the anemia was not found and was not associated with the abscess, then I don't think the providers would have just abandoned that diagnosis in favor of treating the newly discovered abscess. If they were still giving blood and checking the CBC then the anemia was still the focus. This is what you need to look for. The abscess was A focus but did it become THE focus and subsequently the reason for the encounter? Since the abscess and the anemia have no correlation with each other and the purpose of the admission was the symptomatic anemia which was being treated and investigated, then I do not see how you can change the reason for the hospital admission mid stream.

Thank you Debra! I actually re-read the chart and cannot find any documentation that related the anemia/bleeding to the diverticulitis. I didn't consider the diverticulitis as a principal diagnosis.
 

s0lace

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Does the abscess had any bleeding stated anywhere or any abdominal pain while admitiing?

EGD stated no evidence of bleeding and the bleeding was not related to anything at all. She wasn't also experiencing abdominal pain. It was noted that she came in to evaluate the anemia.
 
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EGD stated no evidence of bleeding and the bleeding was not related to anything at all. She wasn't also experiencing abdominal pain. It was noted that she came in to evaluate the anemia.

Then i don't think it needs any further question, just code as Mitchellde said.
 

s0lace

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My auditor agrees that the patient was admitted due to anemia although the invasive diagnostics/therapeutic treatments were directed at the abscess. She said the physician does not have to link the abscess to anemia for the abscess to be coded first. She mentioned that had the patient been diagnosed with anemia only, the length of stay very likely would have been less than 9 days. She also mentioned that the consults and progress notes documentation of abscess drove the thrust of care to that condition. And because there was invasive drainage of the abscess, and, because the more resource intensive treatment and care was directed at the abscess, she's recommending to revise the principal diagnosis to the diverticulitis with abscess.

A manager asked if there's anything on admission that could be linked to the abscess like fever or some abdominal pain.

She said there isn't any, only a slightly elevated WBC. She was admitted with possible acute blood loss anemia. On day 2, they discovered the abscess. The whole chart until discharge summary noted possible ABLA. She said that per her understanding, fluid overload, such as hypervolemia or other visceral fluid collection, can precipitate anemia. She said that because the patient has a diagnosis of possible ABLA but also carried a diagnosis of chronic anemia (in CKD), and had invasive therapy for the abscess, she thought the ABLA should be a secondary diagnosis.

I'm thinking, would you be admitted for something you didn't know existed on day 1 being asymptomatic and all?

Thoughts please? Btw, they're having another auditor review the chart. Thank you.
 
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