Neoplasm/pericardial effusion coding
I have a patient with stage 4 lung cancer that presented with fatigue, cough, and loss of appetite. Initially they thought he had PNA but when they did an ECHO on day one they found a pericardial effusion (malignant). The initial report says no tamponade. The next say the patient had a cardiac arrest and given the pericardial effusion they did a bedside ECHO during resuscitation. This showed R atrial collapse and they did an emergent pericardiocentesis for pericardial tamponade. The patient was resuscitated but was deemed terminal and later died. No definitive treatment was directed at the lung cancer.
I am in discussion with coding and 2 issues have come up.
1. How to code the effusion. The coder thinks that it may be appropriate to only code C7989 (secondary malignant neoplasm) to code the malignant effusion. I don't feel this accurately captures the effusion and think that I39.3 (pleural effusion) should be coded.
2. Sequencing. She currently has C7989 as pdx. I am wondering if we code I39.3 whether this should be pdx. Sequencing guidelines say complications of neoplasm should be Pdx.
How would you code the effusion and what would your Pdx be?
Thanks!
Katy Good, RN, BSN, CCDS, CCS
Clinical Documentation Program Coordinator
Flagstaff Medical Center
Kathryn.Good@nahealth.com
Cell: 928.814.9404
I am in discussion with coding and 2 issues have come up.
1. How to code the effusion. The coder thinks that it may be appropriate to only code C7989 (secondary malignant neoplasm) to code the malignant effusion. I don't feel this accurately captures the effusion and think that I39.3 (pleural effusion) should be coded.
2. Sequencing. She currently has C7989 as pdx. I am wondering if we code I39.3 whether this should be pdx. Sequencing guidelines say complications of neoplasm should be Pdx.
How would you code the effusion and what would your Pdx be?
Thanks!
Katy Good, RN, BSN, CCDS, CCS
Clinical Documentation Program Coordinator
Flagstaff Medical Center
Kathryn.Good@nahealth.com
Cell: 928.814.9404
Comments
This is a tough one for me. I39.3 is not a valid code so I'm not sure what code you are recommending for the pdx.
There is no specific code for malignant pericardial effusion so I can see how the coder came up with C7989. However, see following.
J91.0 (Malig pleural effusion) is a manifestation code and cannot be sequenced as pdx. Underlying condition is to be sequenced first. Per NIH, malignant pericardial effusion is also a manifestation so I think the lung neoplasm might have to be the pdx - if that is the underlying cause.( Cardiac tamponade is not to be sequenced first as well.)
It's Monday morning.... so I may be way off base here. Other's thoughts?
[cid:image001.jpg@01D18368.E0D025B0]
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
Katy Good, RN, BSN, CCDS, CCS
Clinical Documentation Program Coordinator
Flagstaff Medical Center
Kathryn.Good@nahealth.com
Cell: 928.814.9404
Katy Good, RN, BSN, CCDS, CCS
Clinical Documentation Program Coordinator
Flagstaff Medical Center
Kathryn.Good@nahealth.com
Cell: 928.814.9404
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
I appreciate your help
Katy Good, RN, BSN, CCDS, CCS
Clinical Documentation Program Coordinator
Flagstaff Medical Center
Kathryn.Good@nahealth.com
Cell: 928.814.9404
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
Thanks so much.
Katy Good, RN, BSN, CCDS, CCS
Clinical Documentation Program Coordinator
Flagstaff Medical Center
Kathryn.Good@nahealth.com
Cell: 928.814.9404
This is what I was referred in my long lost email regarding query for source of malignant pericardial effusion. Too bad I10 does not have a code for it. Lost some specifically in this case..
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
-----Original Message-----
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Tuesday, March 22, 2016 6:53 AM
To: Salinas, Sharon
Subject: RE:[cdi_talk] Neoplasm/pericardial effusion coding
Malignant pericardial effusion
Coding Clinic, Second Quarter 1989 Page: 12
Effective with discharges: July 31, 1989
Question:
How is malignant pericardial effusion coded?
Answer:
The Alphabetical Index entry for Effusion, pericardium has a (see also Pericarditis) instruction that leads the coder to the following entry:
Pericarditis - . - (with effusion)
neoplastic (chronic) 423.8
acute 420.90.
The physician should be asked if, in this particular instance, the pericarditis is acute or chronic in nature. One of the causes of noninfectious pericarditis with effusion is a tumor, either a primary tumor (benign or malignant) of the pericardial site, or a tumor metastasizing to the pericardium (commonly carcinoma of the lung or breast and lymphomas).
---
CDI Talk is offered for networking purposes. For official rules and regulations related to documentation and coding, please refer to your regulatory source.
You are receiving this message as a member of CDI Talk as: ssalinas@barlow2000.org If you would like to be removed from CDI Talk, please send a blank email to leave-cdi_talk-12538092.1a48df689a710d0d4e067dc4c85563ef@hcprotalk.com
---
Copyright 2013
HCPro, Inc., 75 Sylvan Street, Danvers MA 01923
Confidentiality Notice: This e-mail message, including any attachments, is for the sole use of the intended recipient(s) and may contain confidential and privileged information. Any unauthorized review, use, disclosure or distribution is prohibited. If you are not the intended recipient, please contact the sender by reply e-mail and destroy all copies of the original message.