Acute care and rehab principal diagnosis question
Hi group, long time no talk. Long-winded question coming...
I've been presented with a multipart question regarding selection of the principal diagnosis on patients who are transferred from the acute care setting after orthopedic surgery, to a sister acute care hospital that provides rehab. It's not acute rehab, it's acute care providing rehab services. The coders use a V code for therapy or aftercare as the principal diagnosis.
Second part of the question involves the same setup, but the patient is transferred from the acute care hospital providing rehab back to the original acute care hospital for a medical condition (COPD), then back for rehab when the patient stabilizes. Because there is no mention by the physician of anything other than the COPD after the transfer, the coder is taking COPD as the principal diagnosis in the acute care stay for rehabilitation.
The CDS is concerned because it has been suggested to her that she query the physician as to the principal diagnosis for the acute care stay for rehab. The problem with these cases is that the physicians see them from start to finish as one big continuum, so there's only one H/P and one discharge summary that encompasses preop to discharge home.
Any suggestions or thoughts? Thanks.
Renee
Linda Renee Brown, RN, CCDS, CCS, CDIP
CDI Educator, Novant Health
I've been presented with a multipart question regarding selection of the principal diagnosis on patients who are transferred from the acute care setting after orthopedic surgery, to a sister acute care hospital that provides rehab. It's not acute rehab, it's acute care providing rehab services. The coders use a V code for therapy or aftercare as the principal diagnosis.
Second part of the question involves the same setup, but the patient is transferred from the acute care hospital providing rehab back to the original acute care hospital for a medical condition (COPD), then back for rehab when the patient stabilizes. Because there is no mention by the physician of anything other than the COPD after the transfer, the coder is taking COPD as the principal diagnosis in the acute care stay for rehabilitation.
The CDS is concerned because it has been suggested to her that she query the physician as to the principal diagnosis for the acute care stay for rehab. The problem with these cases is that the physicians see them from start to finish as one big continuum, so there's only one H/P and one discharge summary that encompasses preop to discharge home.
Any suggestions or thoughts? Thanks.
Renee
Linda Renee Brown, RN, CCDS, CCS, CDIP
CDI Educator, Novant Health