"Due to" and "Secondary to"
I believe I was taught that when a condition is secondary to or due to another you code that diagnosis as principal.
Ex/ Weakness due to hyponatremia
or Acute Respiratory Failure secondary to Ex COPD.
Specifically, in the case of the Ac Resp Failure, I understand when two or more diagnoses meet the definition... but it is the linking that is causing me to believe that the Ex COPD should be the primary.
Oh, knowledgeable CDIs & Coders please advise!
Also, some credible reference would be appreciated!
Thanks!
Charrington "Charlie" Morell
Ex/ Weakness due to hyponatremia
or Acute Respiratory Failure secondary to Ex COPD.
Specifically, in the case of the Ac Resp Failure, I understand when two or more diagnoses meet the definition... but it is the linking that is causing me to believe that the Ex COPD should be the primary.
Oh, knowledgeable CDIs & Coders please advise!
Also, some credible reference would be appreciated!
Thanks!
Charrington "Charlie" Morell
Comments
Hope this helps!!!
Judi Bates RN, BSN, CCDS
Our Lady of Lourdes Medical Center
CDI Specialist
856-757-3161
Beeper 66x2906
Juli Bovard RN CCDS
Rapid City Regional Hospital
I'll be honest that I am not totally clear on this and would love to hear opinions from the coders in the group.
Katy Good, RN, BSN, CCDS, CCS
Clinical Documentation Program Coordinator
AHIMA Approved ICD-10CM/PCS Trainer
Flagstaff Medical Center
Kathryn.Good@nahealth.com
Cell: 928.814.9404
Megan Barton RN, BSN
Manager Clinical Documentation Improvement
Health Information Management-Mercy East
Ph: 314-251-6192
Fx: 314-251-3982
"Faye Brown's ICD-9-CM Coding Handbook 2012" says:
- "Assign first the code for the underlying systemic infection followed by the code for Sepsis or Severe Sepsis. When there is an underlying localized infection (e.g. pneumonia, cellulitis, or nonspecific urinary tract infection) with sepsis, severe sepsis, or SIRS: Assign a code for the systemic infection first..."
-"Sepsis or severe sepsis as the principal diagnosis, with the initiating event being a noninfectious condition: Assign first the code for the systemic infection and sepsis codes before the noninfectious condition."
"Associated noninfectious condition and sepsis or severe sepsis both meet the definition of principal diagnosis; either may be sequenced as the principal diagnosis."
I hope this helps.
Robert
Robert S. Hodges, BSN, MSN, RN, CCDS
Clinical Documentation Improvement Specialist
Aleda E. Lutz VAMC
Mail Code 136
1500 Weiss Street
Saginaw MI 48602
P: 989-497-2500 x13101
F: 989-321-4912
E: Robert.Hodges2@va.gov
“Patriotism is easy to understand in America; it means looking out for yourself by looking out for your country" Calvin Coolidge
This is definitely a grey area. First, there are numerous coding guidelines and coding clinics that instruct coders for assignment of conditions "due to" or "secondary to". DM, Sepsis, Respiratory Failure, HIV come to mind.
Secondly, coding guidelines instruct us "Codes for symptoms, signs, and ill-defined conditions Codes for symptoms, signs, and ill-defined conditions from Chapter 16 are not to be used as principal diagnosis when a related definitive diagnosis has been established." Also, would keep in mind UHDDS definition of principal diagnosis “that condition established after study to be chiefly responsible for occasioning the admission of the patient to the hospital for care.”
Respiratory failure and congestive heart failure
Coding Clinic, First Quarter 2005 Page: 5 Effective with discharges: April 20, 2005
Example 3:
A patient arrived in the hospital in acute respiratory failure. The patient was intubated and admitted to the hospital. The patient also has congestive heart failure. The physician documents acute respiratory failure as the reason for admission.
Principal diagnosis:
518.81 Acute respiratory failure
Secondary diagnosis:
428.0 Congestive heart failure, unspecified
In this example, the physician documented the acute respiratory failure as the reason for admission, therefore 518.81 was listed as the principal diagnosis. Selection of the principal diagnosis is governed by the circumstances of admission. If the documentation is unclear regarding whether the congestive heart failure or the acute respiratory failure was the reason for admission, coders should query the physician.
I think the most important questions to ask is what occasioned the admission, what is focus of treatment and what do my coding guidelines say regarding sequencing.
Hope this helps.
Dorie Douthit, RHIT,CCS
ddouthit@stmarysathens.org
CDI Program/HIM
• Treat every case individually, review all of the documentation, then check the coding guidelines and chapter specific rules. This is what we generally remember when assigning the DRG…
• Symptom CODES that are due an underlying conditions go to the underlying condition, unless the differential/"vs"/"and" rules apply.
• Respiratory failure can be a standalone diagnosis or be secondary diagnosis. Resp failure is ALWAYS due to something. It still has its own DRG.. you have to look at what occasioned the admit. I also use a little clinical prioritizing with Resp Failure due to COPD exacerbations-COPD exacerbations are not always in-patient, but Acute Respiratory failure should be.... We have had several HIA Audit reviews that substantiate the use of Resp Failure as principal in the COPD cases. In the cases with CHF and Resp Failure, I look to see if they were related, linked, equally treated and optimize the DRG, if possible.
• Sepsis-if the admit was occasioned by the INFECTION with Sepsis-then Sepsis should be your principal (unless a catheter related infection). Don't forget to check for a vent over 96 hours with Sepsis as Pdx…since that changes the DRG/
If the patient came in with an MI and they were septic from Pneumonia-then what occasioned the admission? Our conclusion: If Infection/Sepsis was not the focal point or what truly would have bought the bed, and there is no chapter specific guideline-you should be able to use MI as the Pdx. I would go with the MI in this case....
Ex: Admitted with Cp x 4 days, n/v, elevated troponins, Inferior lateral MI on EKG with known CAD, NTG gtt started, Morphine IV given. Pt has also had pneumonia for one week prior to admission and was treated with po abx, however the pneumonia has not improved much. The patient may have early sepsis related to pneumonia, start IV abx. Will consult cardiology for heart cath and possible stenting once stable."
☺ -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
vdavis2@armc.com
"The difference between the right word and the almost right word is the difference between lightning and the lightning bug."- Samuel "Mark Twain" Clemens
Chapter 8: Respiratory system diseases coding guidelines 10/01/2008
Coding Clinic, Fourth Quarter 2008 Page: 241 to 244 Effective with discharges: October 1, 2008
Acute Respiratory Failure
1) Acute respiratory failure as principal diagnosis
Code 518.81, Acute respiratory failure, may be assigned as a principal diagnosis when it is the condition established after study to be chiefly responsible for occasioning the admission to the hospital, and the selection is supported by the Alphabetic Index and Tabular List. However, chapter-specific coding guidelines (such as obstetrics, poisoning, HIV, newborn) that provide sequencing direction take precedence.
2) Acute respiratory failure as secondary diagnosis
Respiratory failure may be listed as a secondary diagnosis if it occurs after admission, or if it is present on admission, but does not meet the definition of principal diagnosis.
3) Sequencing of acute respiratory failure and another acute condition
When a patient is admitted with respiratory failure and another acute condition, (e.g., myocardial infarction, cerebrovascular accident, aspiration pneumonia), the principal diagnosis will not be the same in every situation. This applies whether the other acute condition is a respiratory or nonrespiratory condition. Selection of the principal diagnosis will be dependent on the circumstances of admission. If both the respiratory failure and the other acute condition are equally responsible for occasioning the admission to the hospital, and there are no chapter-specific sequencing rules, the guideline regarding two or more diagnoses that equally meet the definition for principal diagnosis (Section II, C.) may be applied in these situations.
If the documentation is not clear as to whether acute respiratory failure and another condition are equally responsible for occasioning the admission, query the provider for clarification.
Chapter 8: Diseases of Respiratory System
Coding Clinic, Fourth Quarter 2011 Pages: 189-190 Effective with discharges: October 1, 2011
c. Acute Respiratory Failure
1) Acute respiratory failure as principal diagnosis
Code 518.81, Acute respiratory failure, may be assigned as a principal diagnosis when it is the condition established after study to be chiefly responsible for occasioning the admission to the hospital, and the selection is supported by the Alphabetic Index and Tabular List. However, chapter-specific coding guidelines (such as obstetrics, poisoning, HIV, newborn) that provide sequencing direction take precedence.
Sharon Salinas, CCS
Barlow Respiratory Hospital
213-250-4200 Extension 3336