Cystic fibrosis
Our physicians document acute exacerbation of chronic bronchitis on CF pt's (along with documentation of CF with pulm
exacerbation/manifestation). There is a debate on what code assignment and final DRG is in this scenario. Coding believes without further documentation, acute exac of chronic bronchitis codes to acute bronchitis 466.0 and final DRG 202 w/ MCC. To me this doesn't seem to appropriately reflect resources consumed, the long lengths of stays (usually>14 days) or complexity of the pt & care. Anyone have a query regarding cystic fibrosis that they could share? Or even a flyer/handout for physician education? I have been querying to clarify whether pt has chronic bronchitis with/without acute bronchitis or to further specify if chronic bronchitis is: mucopurulent, obstructive, other, unknown. Final DRG 190 w/ MCC seems to "fit" better to me than 202.
Any thoughts, suggestions, experiences to share? Thanks in advance.
Coding Clinics found (abbreviated below): VOLUME 19 FOURTH QUARTER
NUMBER 4 2002, Page 45
Cystic Fibrosis
VOLUMES 1 AND 2
NEW/REVISED DIAGNOSIS CODES
In accordance with UHDDS requirements, the condition that occasions the admission to the hospital should be coded as the principal diagnosis. If a patient with cystic fibrosis is admitted due to a complication or manifestation such as pneumothorax, acute bronchitis, acute corpulmonale, the complication or manifestation should be sequenced as the
principal diagnosis and cystic fibrosis reported as an additional diagnosis. If however, the physician determines that the admission is due to the cystic fibrosis rather than a complication, cystic fibrosis should be assigned as the principal diagnosis. This is consistent with advice previously published in Coding Clinic, Fourth Quarter 1990, page 17.
Claudine Hutchinson RN (CDI)
exacerbation/manifestation). There is a debate on what code assignment and final DRG is in this scenario. Coding believes without further documentation, acute exac of chronic bronchitis codes to acute bronchitis 466.0 and final DRG 202 w/ MCC. To me this doesn't seem to appropriately reflect resources consumed, the long lengths of stays (usually>14 days) or complexity of the pt & care. Anyone have a query regarding cystic fibrosis that they could share? Or even a flyer/handout for physician education? I have been querying to clarify whether pt has chronic bronchitis with/without acute bronchitis or to further specify if chronic bronchitis is: mucopurulent, obstructive, other, unknown. Final DRG 190 w/ MCC seems to "fit" better to me than 202.
Any thoughts, suggestions, experiences to share? Thanks in advance.
Coding Clinics found (abbreviated below): VOLUME 19 FOURTH QUARTER
NUMBER 4 2002, Page 45
Cystic Fibrosis
VOLUMES 1 AND 2
NEW/REVISED DIAGNOSIS CODES
In accordance with UHDDS requirements, the condition that occasions the admission to the hospital should be coded as the principal diagnosis. If a patient with cystic fibrosis is admitted due to a complication or manifestation such as pneumothorax, acute bronchitis, acute corpulmonale, the complication or manifestation should be sequenced as the
principal diagnosis and cystic fibrosis reported as an additional diagnosis. If however, the physician determines that the admission is due to the cystic fibrosis rather than a complication, cystic fibrosis should be assigned as the principal diagnosis. This is consistent with advice previously published in Coding Clinic, Fourth Quarter 1990, page 17.
Claudine Hutchinson RN (CDI)
Comments
given by our pulmunologist is that COPD is COPD. Whether it is
emphysema or bronchitis it is treated the same way. If they have
exacerbation of COPD the exacerbation is always acute bronchitis even if
they have emphysematous COPD. He also stated that technically the only
way to know if a pt has emphysema is if you do a CT. But again, I
would get some consensus from medical staff. For your cystic fibrosis
I would look to query more on Acute/Chronic Respiratory failure or
aspiration PNA or something like
that...dehydration...hyponatremia....acidosis/alkalosis maybe?
Deanne Wilk, BSN, RN, CCS
CDI Manager
Good Samaritan Health System
4th & Walnut Streets
PO Box 1281
Lebanon, PA 17042
Desk: 717-270-4804
Mobile work: 717-679-7926
I should have specified most of the cystics I review are
you can get acute resp distress that is better than nothing.
Deanne Wilk, BSN, RN, CCS
CDI Manager
Good Samaritan Health System
4th & Walnut Streets
PO Box 1281
Lebanon, PA 17042
Desk: 717-270-4804
Mobile work: 717-679-7926
peds).
Claudine Hutchinson RN (CDI)
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Wednesday, November 19, 2014 03:33 PM
To: Hutchinson, Claudine
Subject: RE: [cdi_talk] Cystic fibrosis
Gotcha...let me see if I have any peds info on that. Well at least if
you can get acute resp distress that is better than nothing.
Deanne Wilk, BSN, RN, CCS
CDI Manager
Good Samaritan Health System
4th & Walnut Streets
PO Box 1281
Lebanon, PA 17042
Desk: 717-270-4804
Mobile work: 717-679-7926
________________________________
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Wednesday, November 19, 2014 4:30 PM
To: Wilk, Deanne L.
Subject: RE: [cdi_talk] Cystic fibrosis
Thanks Deanne~ I have.
I should have specified most of the cystics I review are
Deanne Wilk, BSN, RN, CCS
CDI Manager
Good Samaritan Health System
4th & Walnut Streets
PO Box 1281
Lebanon, PA 17042
Desk: 717-270-4804
Mobile work: 717-679-7926
chutchinson@saintfrancis.com