More discussion on Post Op Ileus
Our CDI Liaison has advised the following which would prevent the post op ileus from being a complication:
1. For post op ileus = 997.49 + 560.1 + E878x for surgical operation w/ abnormal reaction/later complication, no surgical misadventure
2. If only ileus is documented, but patient was s/p GI surgery = 997.49 + 560.1 + E code-same as above
Reference CC 1st Q, 2012, pgs 6-7 . * Diagnosis code 997.49- digestive system complications, may be reported for an ileus that occurs after surgery,
even if there is not a causal relationship documented. The alphabetic index leads us there*
3. For ileus d/t any other reasons and the patient is not post surgery= 560.1
4. For ileus d/t meds = 560.1 + E code for meds
The ileus code will be assigned based on the above documentation. A coder will not and should not code 997.49 automatically for a diagnosis of ileus.
If ileus occurs following GI surgery, it is coded to 997.49 + 560.1, as per the ICD-9-CM’s Alphabetic Index, which takes precedence over other directives.
If the surgeon says that patient has an ileus (after surgery), that it is an expected outcome of surgery, we would still be coding the diagnosis as documented (997.49 + 560.1 + E878x), but we won’t be coding separate treatment done for it, unless of course, they go back to surgery.
Note that by letting the physicians know about the E878x for surgical operation with abnormal reaction/later complication, no surgical misadventure, is also coded with the 997.49, might help them understand that this is not a punitive code, per se.
Hope this helps,
Charrington "Charlie" Morell
1. For post op ileus = 997.49 + 560.1 + E878x for surgical operation w/ abnormal reaction/later complication, no surgical misadventure
2. If only ileus is documented, but patient was s/p GI surgery = 997.49 + 560.1 + E code-same as above
Reference CC 1st Q, 2012, pgs 6-7 . * Diagnosis code 997.49- digestive system complications, may be reported for an ileus that occurs after surgery,
even if there is not a causal relationship documented. The alphabetic index leads us there*
3. For ileus d/t any other reasons and the patient is not post surgery= 560.1
4. For ileus d/t meds = 560.1 + E code for meds
The ileus code will be assigned based on the above documentation. A coder will not and should not code 997.49 automatically for a diagnosis of ileus.
If ileus occurs following GI surgery, it is coded to 997.49 + 560.1, as per the ICD-9-CM’s Alphabetic Index, which takes precedence over other directives.
If the surgeon says that patient has an ileus (after surgery), that it is an expected outcome of surgery, we would still be coding the diagnosis as documented (997.49 + 560.1 + E878x), but we won’t be coding separate treatment done for it, unless of course, they go back to surgery.
Note that by letting the physicians know about the E878x for surgical operation with abnormal reaction/later complication, no surgical misadventure, is also coded with the 997.49, might help them understand that this is not a punitive code, per se.
Hope this helps,
Charrington "Charlie" Morell