Inpatient Scenarios

shibanshu

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Hi all , myself Shibanshu (CPC) .I do have 3 yrs exp in HCC (outpatient) and 1 yr in Inpatient DRG.
My purpose of creating this thread is to clear some IPDRG doubts. Thanks for the Support!
& feel free to post your doubts too... will be happy to help! Happy coding !
 
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shibanshu

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Patient comes in with fluid overload due to missed dialysis. He does have HTN , ESRD.
He also have CHF/systolic exacerbation. In hospital stay he underwent dialysis.

* In this case what will be the PDX ?

1)HTN
2)Volume overload



Thanks.
 
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Patient comes in with fluid overload due to missed dialysis. He does have HTN , ESRD.
He also have CHF/systolic exacerbation. In hospital stay he underwent dialysis.

* In this case what will be the PDX ?

1)HTN
2)Volume overload



Thanks.

In this case CHF exacerbation will be PDX as Volume overload was an intergral part of CHF, and there is no Cause and effect relationship was established between CHF and hypertension to code HTN as PDX.For further reference please see Fluid overload due to noncompliance with dialysis
Coding Clinic, Second Quarter 2001 Page: 13
Effective with discharges: July 1, 2001
For further assistance i can give additional references

Sandeep podila CPC
 

mitchellde

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Is this due to not showing Up for hemodialysis or not doing the peritoneal dialysis? There are codes in ICD-10 CM for underdosing of the peritoneal dialysis. Then follow the guidelines on reporting underdosing.
 

shibanshu

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Hi Mitchellde

Is this due to not showing Up for hemodialysis or not doing the peritoneal dialysis? There are codes in ICD-10 CM for underdosing of the peritoneal dialysis. Then follow the guidelines on reporting underdosing.


Hi,
The fluid overload is because the patient missed his routine weekly dialysis,
So upto to my knowledge the Fluid overload will go as the Pdx.

Regards
Shibanshu
 

shibanshu

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Hi Sandeep

In this case CHF exacerbation will be PDX as Volume overload was an intergral part of CHF, and there is no Cause and effect relationship was established between CHF and hypertension to code HTN as PDX.For further reference please see Fluid overload due to noncompliance with dialysis
Coding Clinic, Second Quarter 2001 Page: 13
Effective with discharges: July 1, 2001
For further assistance i can give additional references

Sandeep podila CPC


Hi,
I don't think CHF exacerbation will go as the Pdx as the Volume/fluid overload is caused because the pt missed the dialysis.
CHF exa will go only if it is POA (present on admission). I forgot to mention that.

Regards
Shibanshu
 
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Dialysis and chf exacerbation..

First I am sorry that i dont know inpatient guidelines IP- DRG..

But according to iCD 10 Fluid overload can not be coded if CHF exacerbation is there BecauseI50.9 excludes 1 it states fluid overload is there.

Also if the patient is presenting for a condition the intergral part that is signs and symptoms can not be coded together...

So Fluid overload can not be coded if we are coding CHF exacerbation.

Also the patient had dialysis during the hospital stay.. But he/she is not treated for that dialysis.

Accorrding to the research which i am attatching the article url dialysis patients can develop CHF.

http://www.ncbi.nlm.nih.gov/pubmed/7752588

In this case CHF exacerbation is the PDX because it is the worsening state. Even though the dialysis patient undegoing we dont know which stage the patient is in.

If we dont treat dialysis the patient might goes to next level.. But if we dont treat exacerbation conditions it might lead to death.

Exacerbated CHF is an emergency condition and should receive immediate treatment from health professionals

So the priority goes to CHF exacerbation because it is in the worsening state.

Please correct me if i am wrong as i am not a inpatient coder.
 

shibanshu

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Hi

First I am sorry that i dont know inpatient guidelines IP- DRG..

But according to iCD 10 Fluid overload can not be coded if CHF exacerbation is there BecauseI50.9 excludes 1 it states fluid overload is there.

Also if the patient is presenting for a condition the intergral part that is signs and symptoms can not be coded together...

So Fluid overload can not be coded if we are coding CHF exacerbation.

Also the patient had dialysis during the hospital stay.. But he/she is not treated for that dialysis.

Accorrding to the research which i am attatching the article url dialysis patients can develop CHF.

http://www.ncbi.nlm.nih.gov/pubmed/7752588

In this case CHF exacerbation is the PDX because it is the worsening state. Even though the dialysis patient undegoing we dont know which stage the patient is in.

If we dont treat dialysis the patient might goes to next level.. But if we dont treat exacerbation conditions it might lead to death.

Exacerbated CHF is an emergency condition and should receive immediate treatment from health professionals

So the priority goes to CHF exacerbation because it is in the worsening state.

Please correct me if i am wrong as i am not a inpatient coder.





Hi Aparna,

You are correct , but only when chf exa is present on admission.Actually I forgot to mention it , my mistake.


thanks & regards
 
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