Confusion/tremors due to medication
Good Morning
I need some help understanding the Final DRG and if it would be the best DRG in this case.
Chief complaint was tremors and lethargy. Tremors was thought to be due to the accumulation of drugs in the setting of renal failure. Acute renal failure secondary to medication and confusion and lethargy probably poly pharmacy. Pt also went into respiratory failure. All was coded as POA and the PDX was 29281 - drug induced delirium(ICD-9). DRG 896. The patient does not have a history of drug or alcohol abuse and there was no indication or documentation that pt was taking meds incorrectly. Acute renal injury was resolved with IV hydration and by withholding some medications. Confusion and lethargy was exacerbated due to decreased medication clearance from renal fx.
I thought this would go to the renal DRG 682, as it was a manifestation of an adverse affect due to prescribed medication that was taken as prescribed. I asked the coder and she stated the pt had multiple medication adjustments and monitoring and improved with these treatments therefore DRG 896.
If anyone has some input to help me understand I would really appreciate it.
Thanks
Renee, RN CCDS
I need some help understanding the Final DRG and if it would be the best DRG in this case.
Chief complaint was tremors and lethargy. Tremors was thought to be due to the accumulation of drugs in the setting of renal failure. Acute renal failure secondary to medication and confusion and lethargy probably poly pharmacy. Pt also went into respiratory failure. All was coded as POA and the PDX was 29281 - drug induced delirium(ICD-9). DRG 896. The patient does not have a history of drug or alcohol abuse and there was no indication or documentation that pt was taking meds incorrectly. Acute renal injury was resolved with IV hydration and by withholding some medications. Confusion and lethargy was exacerbated due to decreased medication clearance from renal fx.
I thought this would go to the renal DRG 682, as it was a manifestation of an adverse affect due to prescribed medication that was taken as prescribed. I asked the coder and she stated the pt had multiple medication adjustments and monitoring and improved with these treatments therefore DRG 896.
If anyone has some input to help me understand I would really appreciate it.
Thanks
Renee, RN CCDS
Comments
Always difficult to respond fully w/o the chart, but I typically code the acute renal failure as the Principal for such cases, considering the 'degree' of failure of the renal system and therapy directed towards other considered conditions. I'd not use the 292.81 as the PDX given an organ is stated as 'failed'.
Only exception would be if the dysfunctions were 2/2 Non-compliant use of drugs, which would be a poisoning.
Agree w/ you.
Paul
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