? correct code

kwilliams@halifaxrmc.orgkwilliams@halifaxrmc.org
in Clinical & Coding
87 y/o F with hypovolemic shock principal, diverticulosis of large intestine w bleeding, Functional quadriplegia, UTI, and acute blood loss anemia.

DRG 871 Septicemia w MCC. Is that correct? What does sepsis have to do with it?

Thanks to anyone that will respond.

Comments

  • ggoodman@virginiahospitalcenter.comggoodman@virginiahospitalcenter.com
    edited May 2016
    I had this problem too when I had a case with shock as the P.DX with no sepsis. I kept getting 871 for a DRG too. Not sure why it goes to that...



  • katysuegood@gmail.comkatysuegood@gmail.com
    edited May 2016
    Hypovolemic shock routes to the sepsis DRG in ICD-10. This is what I have seen. Just make sure you can support the shock as Pdx over the diverticulosis/bleeding.

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



  • annnd2009@gmail.comannnd2009@gmail.com
    edited May 2016
    Maybe diverticular bleed with hypivolemic shock ?? Query for sepsis due to uti? Shock multi factorial -septic and hypivolemic?...I think Pdx is what caused shock...


  • evanspx@sutterhealth.orgevanspx@sutterhealth.org
    edited May 2016
    That is correct: Shock is classified as an "R" code in the signs/symptoms chapter and is not used as the principal diagnosis if the etiology is stated.

    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





  • ggoodman@virginiahospitalcenter.comggoodman@virginiahospitalcenter.com
    edited May 2016
    But what if the etiology isn’t stated, is unknown, then it would add up in the Sepsis DRG even if there is no sepsis ....right?


  • katysuegood@gmail.comkatysuegood@gmail.com
    edited May 2016
    Yes. I had one like this. Fast admission (death), no underlying cause identified and MD stated as unknown. Shock was the focus of care with no other appropriate Pdx. We ended up in this DRG with no sepsis documented/coded.

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



  • annnd2009@gmail.comannnd2009@gmail.com
    edited May 2016
    I thought hypotension with shock or dehydration... Or wouldn't the cardiac arrest be Pdx if no known cause??


  • evanspx@sutterhealth.orgevanspx@sutterhealth.org
    edited May 2016
    See Guidelines: If cause can't be establish, a code representing a S/S may be used as the PDX...generally to be avoided when possible, but is acceptable under certain circumstances.



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    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










  • katysuegood@gmail.comkatysuegood@gmail.com
    edited May 2016
    Yes. In this case we had no underlying cause and it was the dx that met UHDDS criteria for Pdx. In these cases we can sequence shock as Pdx (just like other symptom codes). We didn’t have a POA(Y) cardiac arrest.

    These cases should be rare but I believe they will occasionally happen.

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


  • kwilliams@halifaxrmc.orgkwilliams@halifaxrmc.org
    edited May 2016
    Thanks so much!


    Kim Williams, RN
    Clinical Documentation Specialist
    Halifax Regional
    Revenue Management Department
    kwilliams@halifaxrmc.org
    (252) 535-8154
    (252) 535-8937 fax







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