med-induced delirim

katysuegood@gmail.comkatysuegood@gmail.com
in Clinical & Coding
I am having a tough time finding an appropriate code for drug-induced delirium? If I go with adverse effect, delirium is not an options when I get to the part of selecting a manifestation. If I try to code the delirium and state it is due to meds it gives me the option of intoxication or withdrawal? If the med is being taken as Rx'd and this is an adverse effect it doesn't seem like either is appropriate?

Thanks!

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

Comments

  • sbourquesbourque
    edited May 2016
    K thanks


  • mark.domineseymark.dominesey
    edited May 2016
    Is encephalopathy a choice? With the majority of delirium being encephalopathy I would consider this an option, if available.

    Mark


  • katysuegood@gmail.comkatysuegood@gmail.com
    edited May 2016
    Hi Mark,
    For the most part, I agree with you though my docs don't always. Some of them believe that delirium is reversible whereas encephalopathy is generally not. Ongoing conversation.....

    However, this particular question is because our quality team is trying to track POA(N) delirium in our patients as a way to encourage better screening, identification, treatment and track results. I am including codes for encephalopathy and delirium in this report but when I was trying to figure this out I was confused by my options when trying to identify med-induced delirium.

    Thanks for your help. Also, if you have any good resources on delirium/encephalopathy please feel free to send them my way ;-)



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

    From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
    Sent: Monday, May 09, 2016 6:06 AM
    To: Kathryn Good
    Subject: Re: [cdi_talk] med-induced delirim

    Is encephalopathy a choice? With the majority of delirium being encephalopathy I would consider this an option, if available.

    Mark


  • katysuegood@gmail.comkatysuegood@gmail.com
    edited May 2016
    Thanks so much Karen! This helps!

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


  • mark.domineseymark.dominesey
    edited May 2016
    Hi Katie, I had a physician explain to me that Delirium is one manifestation (expression) of encephalopathy. Coma is another manifestation, not as frequent. Encephalopathy is caused by something like a disease, or toxicity. If encephalopathy was not reversible, then hepatic encephalopathics would stay full on encephalopathic even after lactulose administration and their ammonia level went down.

    I will locate the resources and the Ven diagram that shows the encephalopathy circle almost completely blocking out the delirium circle.

    Mark



    From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
    Sent: Monday, May 09, 2016 11:02 AM
    To: Mark Dominesey
    Subject: RE: [cdi_talk] med-induced delirim

    Hi Mark,
    For the most part, I agree with you though my docs don't always. Some of them believe that delirium is reversible whereas encephalopathy is generally not. Ongoing conversation.....

    However, this particular question is because our quality team is trying to track POA(N) delirium in our patients as a way to encourage better screening, identification, treatment and track results. I am including codes for encephalopathy and delirium in this report but when I was trying to figure this out I was confused by my options when trying to identify med-induced delirium.

    Thanks for your help. Also, if you have any good resources on delirium/encephalopathy please feel free to send them my way ;-)



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


  • cmclose@saintfrancis.comcmclose@saintfrancis.com
    edited May 2016
    I would be interested in seeing the Ven diagram also Mark~ would you mind sharing it here?
    Thanks.

    Claudine Hutchinson RN (CDI)


  • kbenson@uwhealth.orgkbenson@uwhealth.org
    edited May 2016
    Me too! Thanks!
    Kathy

    Kathleen Benson RN, BSN, CCDS
    Supervisor, Clinical Documentation Integrity
    UWHealth University of Wisconsin Hospital
    Office Location: University Crossing, 749 University Row, Suite 200
    Mailing Location: 600 Highland Avenue, Mail Code 9925
    Madison, WI 53792-9475
    608-516-5638
    kbenson@uwhealth.org



  • Snook@fmchealth.orgSnook@fmchealth.org
    edited May 2016
    We query and attempt to code drug induced delirium as Toxic encephalopathy if they document it as such. One of our references was the 2016 CDI Pocket Guide.

    Mary L. Snook RN-BC
    Clinical Documentation Improvement Specialist
    Fairfleld Medical Center
    401 N. Ewing St.
    Lancaster, Ohio 43130
    snook@fmchealth.org 740-497-4443




  • evanspx@sutterhealth.orgevanspx@sutterhealth.org
    edited May 2016

    Excellent article by James Kennedy, MD, CCS, on this topic.

    PE

    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


  • Snook@fmchealth.orgSnook@fmchealth.org
    edited May 2016
    We also used this excellent piece as a resource. Our Neurologists loved it!.


    Mary L. Snook RN-BC
    Clinical Documentation Improvement Specialist
    Fairfleld Medical Center
    401 N. Ewing St.
    Lancaster, Ohio 43130
    snook@fmchealth.org 740-497-4443



    From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
    Sent: Monday, May 09, 2016 12:16 PM
    To: Mary Snook
    Subject: RE: [External] Re: [cdi_talk] med-induced delirim

    Excellent article by James Kennedy, MD, CCS, on this topic.

    PE

    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



  • mark.domineseymark.dominesey
    edited May 2016
    Yes, Paul, this is a good resource as is the source resource Dr. Kennedy mentions (Posner). This what I meant by almost all delirium being caused by encephalopathy, which in turn is typically caused by something outside of the brain (i.e. not caused by a structural problem with the brain).

    I will look for the resource where I saw the Ven diagram and report it here when I find it (may take me a couple of days as many of now know I have a new job!)

    Mark




  • katysuegood@gmail.comkatysuegood@gmail.com
    edited May 2016
    I have also been working off of that White Paper. Always looking for additional resources though, especially with this dx.

    Thanks everyone!

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


  • arozhkovskayaarozhkovskaya
    edited May 2016
    Could you, please send the link for this article, guys?
    It would be greatly appreciated.

    Anna Rozhkovskaya, RHIT, CCS, CCS-P,
    Manager Clinical Documentation Improvement
    HIM, Memorial HealthCare System,
    (954)265-6974 (Cisco)
    (954-276-9957 (Office)


  • utuk350@hotmail.comutuk350@hotmail.com
    edited May 2016
    I concur with Mark. Encephalopathy- reversible or non reversible depends on its etiology.

    Margaret Utuk, RN


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