CVA or A-fib as principle Dx?

mdominesey

A-fib on its own is not admittable, but it is the cause of the CVA. Both obviously POA. Majority of the workup and resources directed at the CVA, but rate control meds were adjusted for A-fib.

Would the A-fib w/ MCC be the most appropriate or, would the CVA with A-fib and a CC (C-diff) be best? Difference is less than 0.08 in DRG weight. (I am thinking stroke would be the most appropriate principle).

Is there a Coding Clinic that states cause of CVA should be the principle? (just want to have my ducks in a row before talking to coding mgr)

Thanks,

Mark



Mark N. Dominesey, RN, BSN, MBA, CCDS, CDIP
Clinical Documentation Excellence
Sr. Clinical Documentation Improvement Specialist
Sibley Memorial Hospital

Information Technology
5255 Loughboro Rd NW
Washington DC, 20016-2695

W: 202.660.6782
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mdominesey@sibley.org

http://www.sibley.org




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ssalinas

Best fit scenario I find in CC is below. If both treated equally, you can use either one.

Diastolic congestive heart failure due to atrial fibrillation
      Coding Clinic, First Quarter 2012 Pages: 7-8 Effective with discharges: April 1, 2012

Question:

A 78-year-old male patient with history of atrial fibrillation (A-fib) presented to the emergency department with midsternal chest discomfort. He was given sublingual nitroglycerin and aspirin as well as Lasix. At the time of admission, provider documentation indicated diastolic congestive heart failure (CHF) likely due to atrial fibrillation (A-fib). The heart failure resolved with intravenous diuretics and the A-fib was converted to normal sinus rhythm. Both diastolic congestive heart failure and A-fib are listed as discharge diagnoses. In this case, what is the appropriate sequencing of the principal diagnosis?

Answer:

If both conditions are present on admission and meet the definition of principal diagnosis, either condition may be sequenced as principal diagnosis. The Official Guidelines for Coding and Reporting, Section II, B., state, "When there are two or more interrelated conditions (such as diseases in the same ICD-9-CM chapter or manifestations characteristically associated with a certain disease) potentially meeting the definition of principal diagnosis, either condition may be sequenced first, unless the circumstances of the admission, the therapy provided, the Tabular List, or the Alphabetic Index indicate otherwise." If, however, one of the conditions is clearly documented as causing the admission, then that condition should be designated as the principal diagnosis. See also Coding Clinic, Second Quarter 1990, page 4, for additional examples.




© Copyright 1984-2012, American Hospital Association ("AHA"), Chicago, Illinois. Reproduced with permission. No portion of this publication may be copied without the express, written consent of AHA.

Sharon Salinas, CCS
Barlow Respiratory Hospital
213-250-4200 Extension 3336

ddouthit

Mark,

There is not a coding clinic that addresses sequencing of CVA and a-fib. I would use UHDDS guideline of principal diagnosis. Did the patient come in symptomatic from CVA and was focus of treatment CVA?
I personally would code CVA with A-fib secondary if focus of treatment was on CVA.

Dorie Douthit, RHIT,CCS

elizabeth.hynd

Our coders won't go there. Often afib is a chronic condition, another reason to code the CVA first.

Elizabeth Hynd RN, BSN, CPUR
Clinical Documentation Specialist
863-687-1100 ext. 7313