Dx sequence help


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Hello everyone,

Can someone help with the following scenario:

A consult was called because the patient has a past history of pulmonary embolism (1985 and 1991) The patient was admitted for having GI bleed. The patient was found to have a HX of PE, the ER put a consult order in for HX of PE.
In the consult impression, the doctor list the following DX's:
HX of PE v12.51
palpitations 785.1
GI bleed 578.9
obesity 278.00

In the recommendations everthing is geard towards treating the HX of PE, including medicatons.
I checked if that particulr V code can be used first, and in the ICD-9 it states it can be used 1st or 2nd. There is no clear indication to me if the GI bleed is relative to the HX of PE. The doctor listed the HX of PE ist and the GI bleed as 3rd. I usually don't go by the doctor's sequence, but it appear his sequence is correct based on the documentation given.

I just want to know should I use the vcode first and the GI 2nd, or the GI first?:cool:


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If the admitting complaint was GI bleed, I would want to have that as the primary dx. Although different body systems are referenced, it may indeed be related to the HX of PE as both involve circulatory issues.