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

Comments

  • Hi, Renee

    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

    Paul Evans, RHIA, CCS, CCS-P, CCDS
     
    Manager, Regional Clinical Documentation & Coding Integrity
    Sutter West Bay
    633 Folsom St., 7th Floor, Office 7-044
    San Francisco, CA 94107
    Cell:  415.412.9421

    evanspx@sutterhealth.org



  • I am with you Renee, I would go with Renal failure as Pdx given what you have said.

    Katy Good, RN, BSN, CCDS, CCS
    Clinical Documentation Program Coordinator
    AHIMA Approved ICD-10CM/PCS Trainer
    Flagstaff Medical Center
    Kathryn.Good@nahealth.com
    Cell: 928.814.9404

  • edited April 2016
    I think Renal Failure also since that is what caused the medications to accumulate.

    Theresa Crosslin RN CM
    Cookeville Regional Medical Center
    931-783-2078
    TCrosslin@crmchealth.org


  • edited April 2016
    I agree with renal failure as well.




    Julie Monty

    RN, CDIS

    HIM Dept.

    (518) 314-3476

    JMonty@cvph.org

    The University of Vermont Health Network

    Champlain Valley Physicians Hospital

    UVMHealth.org/CVPH

  • edited April 2016
    Could you get encephalopathy d/t meds (toxic)

  • edited April 2016
    Bromides for a couple dozen years might give you a toxic encephalopathy. Long term use of drugs that poison brain cells can get you a toxic encephalopathy. Being sedated by sedatives, being tranquilized by tranquilizers, getting high from legal or illegal drugs is not encephalopathy. What meds do you have in mind?

    Robert S. Gold, MD
    CEO, DCBA, Inc
    4611 Brierwood Place
    Atlanta, GA 30360
    (770) 216-9691 (Office)
    (404) 580-0204 (Cell)

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