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)

Comments

  • edited April 2016
    I would talk to your pulmunologist or hospitalist. The direction I was
    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

  • Thanks Deanne~ I have.

    I should have specified most of the cystics I review are
  • edited April 2016
    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

  • Yes it is, and thank you Deanne~ I'd appreciate any info (especially
    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
  • edited April 2016
    Send me your email Claudine..



    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

  • Deanne:

    chutchinson@saintfrancis.com
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