Erosion of lap band

lsipos@monument.healthlsipos@monument.health
edited December 2018 in CDI Talk Archive
Good morning. I have an INPT diagnosis of Erosion of lap band and am getting T85518A for the Code (Breakdown (mechanical) of other gastrointestinal prosthetic devices, implants and grafts, initial encounter) with a lap removal of a gastric band and port with gastrorrhaphy.

The coder thinks K95.09 is a better code but I think that this implies the complication is more related to the actual procedure. ( Other complications of gastric band procedure)

Suggestions, comments? Coding clinics? Literature?

Thanks!

Juli

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Comments

  • lsipos@monument.healthlsipos@monument.health
    edited March 2016
    I have an issue where we are reviewing some surgical DRG's as they seem to have had an increase in the o/e ratio.
    I came across a chart where the patient had ACUTE GS pancreatitis (documented throughout the record) with known and documented chronic cholecystitis and chronic cholelithiasis. Even on the OP note it says CHRONIC cholecystitis.

    We DID do a lap chole without CDE. I understand we don't do surgery for this randomly and was wondering what the correct DRG would be? I had DRG 418. The coder 417

    The coder has taken the Pancreatis as the MCC and I feel the GS pancreatitis should be the PDX and not the MCC. She is using K80.18 "Calculus of the gallbladder w other cholecystitis w/o obstruction as PDX", and also using Acute pancreatitis unspecified (k85.9) and K80.66 calculus of GB and bild duct w Ac and chronic cholecystectomy w out obstruction.

    My go-to coder extraordinaire says that she is going to send this to HCPRO for advice. In the meantime...
    Any takers and suggestions on what the CDI world or other coders out there think? :)...or DR. GOLD?

    TIA

    Juli


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  • jenniferan@mcmc.netjenniferan@mcmc.net
    edited March 2016
    I am a new CDI that has been book taught as I am the only one in the department and this is a new position. I looked at my first chart yesterday in my new role and thought that there may be a possibility for 2 queries, however, after asking the inpatient coder to review my thought processes, she thought I had no basis. I would like to know whether I am on the right track or totally not getting it.
    Patient is a 93 year old female with a history of vascular dementia, lymphoma, major depression, chronic af, cerebral atrophy. The Ed doc states in her H/P that when EMS arrived, she was hypoxic with sats of 88% on ra. In the ED, she was sob, tachycardic, tachypneic, sats 84%, in respiratory distress. The ED nurse documented that she was requiring 10L via NRB to maintain sats > 90%. Also in the ED notes, she presented with increasing confusion which worsened abruptly that day with somnolence, fever and uncommunicative. The attending physician states that her confusion has resolved and she is now back to baseline, following commands and communicating appropriately. She was started on 3 lots of ivab on admission. The "causative factor (pneumonia) is being corrected and therefore she has returned to baseline.

    Based on the above information, and I know that it is probably an easy answer considering all of the complex questions that are put forward on this site, should I query the attending for acute respiratory failure or metabolic encephalopathy, both or none. Many thanks and I thank god for all of your knowledge on this site. I really enjoy reading and learning from you all.
  • jenniferan@mcmc.netjenniferan@mcmc.net
    edited March 2016
    Thank you for all the feedback, encouragement and engagement. And Katy, you are right. I think unfortunately, because I am "brand new" so to speak and this is a new position in the hospital, I do not think that the coder has an understanding of what my role is exactly. And, because I am on my own, I have no-one in house to guide me. However, I want to thank you all because I am no longer second guessing if I am actually in the right job and I have just sent out the query to the physician.
    Jennifer Hecker RN BSN
    Mid Columbia Medical Center
    jenniferan@mcmc.net
    5415066411
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