How to code & sequence

cruby82@yahoo.com

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A provider wrote in A&P
1.Acute hypoxic respiratory failure secondary to adenovirus URTI with superimposed pneumonia
2.Septic shock secondary to pneumonia
 
Based on the information provided, it's really difficult to say which one goes first. Chapter 10 in your ICD-10-CM guidelines provides information about respiratory failure. Pretty much, it states that respiratory failure could be principal or secondary diagnosis, it's all based on what exactly what the patient admitted for, what was the main focus of treatment. This is the guideline.

3) Sequencing of acute respiratory failure and another acute condition
When a patient is admitted with respiratory failure and another acute condition, (e.g., myocardial infarction, cerebrovascular accident, aspiration pneumonia), the principal diagnosis will not be the same in every situation. This applies whether the other acute condition is a respiratory or nonrespiratory condition. Selection of the principal diagnosis will be dependent on the circumstances of admission. If both the respiratory failure and the other acute condition are equally responsible for occasioning the admission to the hospital, and there are no chapter-specific sequencing rules, the guideline regarding two or more diagnoses that equally meet the definition for principal diagnosis (Section II, C.) may be applied in these situations.
If the documentation is not clear as to whether acute respiratory failure and another condition are equally responsible for occasioning the admission, query the provider for clarification.

hope this helps!
 
Based on the information provided, it's really difficult to say which one goes first. Chapter 10 in your ICD-10-CM guidelines provides information about respiratory failure. Pretty much, it states that respiratory failure could be principal or secondary diagnosis, it's all based on what exactly what the patient admitted for, what was the main focus of treatment. This is the guideline.

3) Sequencing of acute respiratory failure and another acute condition
When a patient is admitted with respiratory failure and another acute condition, (e.g., myocardial infarction, cerebrovascular accident, aspiration pneumonia), the principal diagnosis will not be the same in every situation. This applies whether the other acute condition is a respiratory or nonrespiratory condition. Selection of the principal diagnosis will be dependent on the circumstances of admission. If both the respiratory failure and the other acute condition are equally responsible for occasioning the admission to the hospital, and there are no chapter-specific sequencing rules, the guideline regarding two or more diagnoses that equally meet the definition for principal diagnosis (Section II, C.) may be applied in these situations.
If the documentation is not clear as to whether acute respiratory failure and another condition are equally responsible for occasioning the admission, query the provider for clarification.

hope this helps!
I'm sorry but this does not help and why I decided to ask for AAPC's help. What I wrote is all I got and there is no querying the provider for clarification because they are hospitalists and only do the billing for them and coding when needed which is almost most of the time because what gets sent isn't even close LOL

I was going with this
J12.0 (that's if the adenovirus URTI with superimposed pneumonia can be a combo code & linked together)
J96.01
A41.9
R65.21

Thoughts?
 
That's really always the case, alot of the time providers don't know the rules/sequencing/guidelines of coding, and specially about combo codes.

I'm sorry my information wasn't helpful, but again that's what is written. One thing about coders is that we cannot assume, since we don't have a medical license. The reason why i provided that guideline is because your first diagnosis could be resp failure, or it could be adenovirus URTI, or it could be pneumonia, which one goes first? that depends on what was documented and supported that was responsible for the patient to be admitted. Unfortunately me telling you what code goes first is me assuming without even reading the patient record.

Also, the way I would code it will be the following.

Acute hypoxic resp failure - J96.01
URTI w adenovirus - J06.9 and B97.0
Pneumonia - J18.9 (pneumonia is a lower resp infection, not the same as an upper resp infection, so i would not link the adenovirus to pneumonia)
septic shock - A41.9 and R65.21

just keep in mind, Acute resp failure could go first, URTI w virus could go first, pneumonia could go first, that's why the guideline states the selection of the code is based on the circumstances of admission. If i have to take a while guess i would assume they were treating the resp failure primarily so would put that first, but again i'm assuming which is not the right step.

That's my best help I can provide, unless someone else has a different point of view.
 
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