PDX severe Aortic stenosis vs. Acute CHF
Hello all. Just throwing a question out there to my fellow CDI's.... If you have a patient with Severe Aortic Stenosis that is inoperable due to multiple comorbidities, and the patient is readmitted quite frequently with fluid overload from the AS or with a documented Acute systolic, diastolic CHF, would the DRG go to the CHF(DRG 291, 292, 293) or to the Severe AS (DRG 306,307)? This will be a focus for those patient that are readmitted within 30 days with a CHF diagnosis.
Thank you.
Barbara Lefevre RN BSN CCDS
Saint Mary's Hospital
Waterbury, Conn.
Thank you.
Barbara Lefevre RN BSN CCDS
Saint Mary's Hospital
Waterbury, Conn.
Comments
Cindy
I would agree, that the CHF would be the principal if that is what is being treated and not the AS.
We have gone round on this and while it doesn't seem consistent ...maybe you could query for hypertensive heart disease/cardio renal--- often cause of the AS (if renal component there) Cardiorenal is sometimes easier for us than hypertensive heart disease but codes the same and will take the Chf with specificty for the mcc.
On Aug 22, 2012, at 12:42 PM, CDI Talk wrote:
> Acute Chf would be PDX Charlene
>
>
Sharon Salinas, CCS
Barlow Respiratory Hospital
213-250-4200 Extension 3336
A patient comes in with symptoms such as SOB, chest pain or syncope. Tests are done and the cause is determined/presumed to be AS - AS is the principal dx. Of course if a cardiac cath is done, the DRG changes to 286 or 287. Other surgeries will change it to the surgical DRGs.
Below is a somewhat similar scenario, except that they actively treated both conditions, and even in this case, the response is that either can be principal. In your scenario I think the CHF would be the principal since it was the only thing treated. Will be watching for other opinions.....
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.
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Two or more interrelated conditions as principal guideline 1990
Coding Clinic, Second Quarter 1990 Page: 4 Effective with discharges: April 1, 1990
Example 2: A patient was admitted with acute atrial fibrillation with rapid ventricular response and was also in heart failure secondary to the atrial fibrillation. The patient was digitalized to reduce ventricular rate and given IV Lasix to reduce the pulmonary edema related to heart failure. Both conditions potentially meet the definition of principal diagnosis. Either may be sequenced first.
© 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