Newborn/suspect Sepsis

mmunoz21

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Hello everyone,

I see professional and hospital claims, I know in the professional side we do not code "suspected or rule out", . I came accross a couple of claims, where the DX used 771.81, then 2-days later lab work shows no Sepsis, but the facility keeps the 771.81 DX. Has anyone seen this before and is this acceptable?
 

007CPC

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Good question!

I am currently trying to get a career start as an inpatient coder, so it will be interesting to hear the answer.
 

ARCPC9491

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Hi, I'm not a facility coder expert... but I know a little bit.:)

Go to google and type in Official ICD9 guidelines, it's a great reference to have.

They specifically state for short term, long term and acute care facilities, you can code the rule out condition at the time of discharge if no definitive diagnosis has been made.

Hope that helps....:)
 

007CPC

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Hi, I'm not a facility coder expert... but I know a little bit.:)

Go to google and type in Official ICD9 guidelines, it's a great reference to have.

They specifically state for short term, long term and acute care facilities, you can code the rule out condition at the time of discharge if no definitive diagnosis has been made.

Hope that helps....:)
Guidelines for rule out, ruled out, possible, are in the first or second chapter (usually the chapter on UHDDS guidelines) of every facility coding book written! I think the point to the post is: if a patient concludes with admissions to discharge, what is the point to having the code 771.81 appended to the patient's chart, seeming allot of times coders in the professional side of the industry tend to retrieve diagnoses in the past and apply them to current procedures even when the patient's condition has resolved and that condition is not the reason for encounter or service in order to get paid. I guess the purpose to have that type of diagnosis appended to the patient's medical history is for statistical purposes utilized by statisticians. I think! Hopefully someone can come through with a transparent answer.

( I think that my paragraph is a sentence fragment) (I just learned that the doc I work for, who is a writer, makes grammar mistakes sometimes. So I don't feel that bad with my poor grammar skills; They will improve)
 

mmunoz21

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Thanks, I checked th inpatient DX guidelines and yes they are allowed to bill the condition if the suspect. But once after you determined that the patient does not have Sepsis, why would you still leave that code, if not just for monetary gain, because DRG for Sepsis is of high value. I have not found clarification on what to do once you determined that the pt does not have Sepsis, why still code for Sepsis...

Confusing....
 

nikkilynne

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Newborn/Suspect Sepsis

** I code for a facility (Inpatient charts), and when we have a newborn with suspected Sepsis or R/O Sepsis, and if at the time of discharge is still suspected or yet to be ruled out, we code the Sepsis Dx per coding guidelines.

** If the physician documents any signs or symptoms as the reason for suspecting Sepsis, but at the time of discharge, Sepsis has been ruled out, we code the signs or symptoms documented.

** If the physician doesn't document any signs or symptoms as the reason for the suspected Sepsis, and at the time of discharge Sepsis has been ruled out, we code a V29.0 code for a suspected infectious condition of a newborn not found. I am not sure if the V29.0 code would be acceptable for the physician side of coding or not.

Hope this info is useful.
Nikki Lynne
 
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You can not rule out sepsis with lab tests. A negative blood culture DOES NOT mean the patient is not septic. If the patient has the clinical indicators for sepsis and is being treated for sepsis it is appropriate to code sepsis even if the culture is negative.
 

cordelia

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I agree with twilson, a negative culture does not necessarily mean the patient isn't septic (there are issues with collecting samples, contamination, etc). According to the UHDDS guidelines, if a patient is being treated for a condition, even if it hasn't been definitely ruled in or out by the time of discharge, this can be coded.

Cordelia, CCS, CPC
 
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