Coding Large Bowel Obstruction d/t Constipation

I am looking for the opinions of the group regarding a situation where there is a conflict in opinion between the CDS and coder. Patient with a significant hx of multiple abdominal surgeries including a colostomy that was reversed, was admitted w/ abdoiminal pain and n/v. CT showed partial large bowel obstruction (w/ marked distention up to 6 cm in diameter) vs. ileus so she was admitted with the diagnosis of Partial Large Bowel Obstruction. She was kept NPO and had NG placed w/ 1:1 replacement. Pt was having liquid stools and on day 3 her NG output was still high and abd xray showed "more gaseous distention of the colon." It was decided at this point to do a gastrografin enema which showed no obstruction. By day 4 she was doing much better, NG was removed, started on clears, and she was d/c'd on day 5.

The final diagnosis was large bowel obstruction secondary to constipation. The coder wants to code this to constipation with the rationale that the gastrografin enema showed no obstruction, therefore was ruled out. I felt that is should be coded to large bowel obstruction because 1) that is what was treated and consistently documented throughout the chart and 2) the gastrografin enema was done on day 3 and the obstruction could have resolved at that point.

Any thoughts would be appreciated.



  • I would also want the SBO. I would just query the MD if there is any problem. Clearly this was more than simple constipation.

    Katy Good, RN, BSN, CCDS, CCS
    Clinical Documentation Program Coordinator
    AHIMA Approved ICD-10CM/PCS Trainer
    Flagstaff Medical Center
    Office: 928.214.3864
    Cell: 928.814.9404

  • edited May 2016
    If the physician documented on discharge large bowel obstruction secondary to constipation, I would code the obstruction as principal. Sounds like large bowel obstruction RESOLVED with treatment not ruled out.

    Dorie Douthit, RHIT,CCS
    CDI Program/HIM

  • Key Statement: The MD documented a DISCHARGE diagnosis is SBO - the
    SBO is coded and the constipation, a symptom of the SBO is not coded at

    Paul Evans, RHIA, CCS, CCS-P, CCDS

    Supervisor, Clinical Documentation Integrity, Quality Department
    California Pacific Medical Center
    2351 Clay #243
    San Francisco, CA 94115
    Cell: 415.637.9002
    Fax: 415.600.1325
    Ofc: 415.600.3739
  • Exactly Paul. I am confused why this is an issue.
    Then again, I was confused as to why my issue a week ago with a coder was an issue too. We all have these experiences from time to time.

    Katy Good, RN, BSN, CCDS, CCS
    Clinical Documentation Program Coordinator
    AHIMA Approved ICD-10CM/PCS Trainer
    Flagstaff Medical Center
    Office: 928.214.3864
    Cell: 928.814.9404

  • edited May 2016
    I agree with the LBO being coded principle

    Tracy M Peyton RN, CCDS
    Bradford Regional Medical Center
    Upper Allegany Health Systems
    116 Interstate Parkway
    Bradford, PA 16701
  • Thanks for the responses. I agree to the confusion as to why this is even an issue. Unfortunately, this is not a new problem with this coder. Her coding is so inconsistent and seems to be passive aggressive in nature. One week she will code a diagnosis off its mention in one consultant note and the next week she won't code a diagnosis that is documented in three different consultant notes. It is very frustrating!
  • edited May 2016
    I agree! This is where the clinical perspective sheds light to this case. Looking at the medical necessity/severity of illness will help guide you in this case! Does constipation usually buy you an inpatient stay? Do you usually get you an NGT for just constipation? Not usually! If I had any doubt, I would just talk with the doc! The note likely means "No obstruction NOW."... If I ever have to have an NGT, I need to hear more than I am just constipated!!!

    Y'all have a good weekend!!! -V

    Vicki S. Davis, RN CDS
    Clinical Documentation Improvement Manager
    Health Information Management Department
    Alamance Regional Medical Center
    Office (336) 586-3765
    Ascom Mobile (336) 586-4191
    Fax (336) 538-7428

    "The difference between the right word and the almost right word is the difference between lightning and the lightning bug."- Samuel "Mark Twain" Clemens

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