Question about sepsis and Narcotic Overdose

cynthia.hudson@christushealth.org

Team (I hope you are out there today Dr. Gold),
We have a patient who was admitted for overdose of narcotics-intentional-self medication for pain with multiple drugs. He also was found to have sepsis present on admission, likely from aspiration because he was so lethargic from the medication. The CDI nurse sequenced the overdose as the principal diagnosis. The coder feels that the sepsis should be principal. Both of these diagnoses have strong guidelines about principal diagnosis assignment. What about when both of the conditions are together at the same time? What should the principal diagnosis and is there a coding clinic for this situation?

Looking forward to hearing your expert wisdom.
-Syndi

Syndi Hudson, RN, CCDS,CCM
CHRISTUS Santa Rosa New Braunfels
CDI Specialist
cynthia.hudson@christushealth.org
830-643-6116 (Office)
830-643-5139 (Fax)
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"We are His hands". Isaiah 64:8



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jmonty

I am under the impression that the OD always has to be sequenced first, regardless of the other diagnoses.


Julie Monty
RN, CCDS
HIM Dept.
(518) 314-3476
JMonty@cvph.org
The University of Vermont Health Network
Champlain Valley Physicians Hospital
UVMHealth.org/CVPH

ssalinas

Poisonings and ODs can be confusing. The poisoning/OD code should always be sequenced before any manifestations of the OD. My understanding is that does not necessarily mean the OD has to be the principal diagnosis. Depending on the circumstances of the admission, other unrelated diagnoses can be sequenced as the principal diagnosis.

In the scenario below, careful review of the admission documentation would be required to determine which actually occasioned the admission. This might be the case of 2 unrelated diagnoses meeting the definition of principal diagnosis.

Other thoughts?

Sharon Salinas, CCS
Health Information Management
Barlow Respiratory Hospital
2000 Stadium Way, Los Angeles CA 90026
Tel: 213-250-4200 ext 3336
FAX: 213-202-6490
ssalinas@barlow2000.org

katysuegood@gmail.com

I think it comes down to... what was the focus of care? Would the OD alone have required IP admission? What was the treatment/evaluation provided and what was most resource intensive? Ultimately, I would take it back to the UHDDDS guidelines for principle dx.

Katy Good, RN, BSN, CCDS, CCS
Clinical Documentation Program Coordinator
Flagstaff Medical Center
Kathryn.Good@nahealth.com
Cell: 928.814.9404

evanspx@sutterhealth.org

I'd add that "IF" the OD (Poisoning) caused the apparent Aspiration Pneumonia, which led to sepsis, the OD, per message earlier from Sharon, is the Principal Diagnosis...that is 'the' question.

Per Guidelines, 'any/all' consequences of Poisoning are coded as a consequence of the poisoning...this is logical, if one considers there would have been no Aspiration Pneumonia with a manifestation of sepsis had the patient not taken the drugs.

My advice predicated on this chain of events:

1. OD > 2. PNA > 3. Sepsis.



Paul Evans, RHIA, CCS, CCS-P, CCDS

Manager, Regional Clinical Documentation
Sutter West Bay
633 Folsom St., 7th Floor, Office 7-044
San Francisco, CA 94107
Cell: 415.412.9421



evanspx@sutterhealth.org

cynthia.hudson@christushealth.org

Thank you for the explanation! I will pass this on to my team. Your explanation is very helpful.

Syndi Hudson, RN, CCDS,CCM
CHRISTUS Santa Rosa New Braunfels
CDI Specialist
cynthia.hudson@christushealth.org
830-643-6116 (Office)
830-643-5139 (Fax)
 
“We are His hands”. Isaiah 64:8