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Wiki Melena in NEC

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colebean76

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There has been an ongoing debate regarding coding melena in a newborn when NEC is also diagnosed. In the past, melena wasn't picked up because it was felt it was a symptom of NEC. Lately, there has been discussion that melena isn't always present when a patient has NEC, and it should be picked up as a secondary (basically, they can diagnose NEC without melena being a symptom). We've looked at the various stages of NEC, and what symptoms are present with each stage, but it's still being debated on whether or not to pick up the melena in addition to NEC, no matter the stage.
I'm simply wondering how other facilities may handle this scenario. Thanks in advance for any help you can give us!!
 
In the absence of excludes notes in ICD-10, we consult the Merck Manuals. "[G]ross blood in stool" is listed as both a symptom/sign and one of the "initial manifestations" of NEC. I wouldn't code melena in a pt with NEC unless documentation stated it was unrelated.
 
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