Rhabdomyolysis

debra.stewart@halifaxregional.com

I have a question for CDI/coding.  If you have a patient that has had a Fall (elderly) cant get up for hours , family finds them down, they are admitted for acute rhabdomyolysis.  How would you code this.  I see this as a trauma effect causing Rhabdomyolysis.  But if you dont go to trauma for this you get a different DRG one for Tendonitis, myositis/Bursititis etc. 

morris-jeff@CooperHealth.edu

Are your MD's documenting that it's secondary to trauma? From my adult nursing experience (many moons ago) a lot of these patients were already dehydrated or sick and sometimes it was more than a few hours before they are found. With these patients the rhabdo was often caused by dehydration.

evanspx@sutterhealth.org

Not quite sure how one would distinguish the cause of this in a patient that is 'found down'...what I see stated is pt found on floor with subsequent rhabdo (and often ARF 2/2 to the rhabo).  I'd imagine either trauma or dehydration could case the rhabdomyolysis in such cases.  These present with muscle injury due to a fall and/or prolonged recumbent position and are  also dehydrated.  Bit of a paradox? 

Paul Evans, RHIA  CCDS

bbogda@morrishospital.org

Our docs are pretty good about relating the rhabdo to the fall.  But I have to say that we have had some pretty dehydrated patients and I am pretty certain I have never seen rhabdo as a result.  More likely ATN?

kbalogun

Code either, both present on admission!

evanspx@sutterhealth.org

Per multiple issues in AHA coding clinic,  ATN must be the principal diagnosis whether due to either rhabdo and/or dehydration.   ATN = PDX.

christine.butka@hmhn.org

If a patient is found on the ground 12 hours after falling and fracturing  a hip and the physician documents "rhabdomyolysis due to fall " due to an elevated CK.  Does this get coded as traumatic rhabdomyolysis? I'm asking because this diagnosis along with a hip fracture as principle, codes to the multi system trauma DRG. Patient had surgery for fracture and went home in 3 days. Traumatic rhabdomyolysis, I feel is related to trauma such as a car accident or a crush injury. I don't equate traumatic rhabdomyolysis with someone found on the floor.  Thoughts?

bbogda@morrishospital.org

http://www.webmd.com/a-to-z-guides/rhabdomyolysis-symptoms-causes-treatments#1

Rhabdomyolysis Causes

There are many traumatic and nontraumatic causes of rhabdomyolysis. In the first category, causes include:

Traumatic

• A crush injury such as from an auto accident, fall, or building collapse
• Long-lasting muscle compression such as that caused by prolonged immobilization after a fall or lying unconscious on a hard surface during illness or while under the influence of alcohol or medication
• Electrical shock injury, lightning strike, or third-degree burn
• Venom from a snake or insect bite

Nontraumatic:

• The use of alcohol or illegal drugs such as heroin, cocaine or amphetamines
• Extreme muscle strain, especially in someone who is an untrained athlete; this can happen in elite athletes, too, and it can be more dangerous if there is more muscle mass to break down.
• The use of medications such as antipsychotics or statins, especially when given in high doses
• A very high body temperature (hyperthermia) or heat stroke
• Seizures or delirium tremens
• A metabolic disorder such as diabetic ketoacidosis
• Diseases of the muscles (myopathy) such as congenital muscle enzyme deficiency or Duchenne's muscular dystrophy
• Viral infections such as the flu, HIV, or herpes simplex virus
• Bacterial infections leading to toxins in tissues or the bloodstream (sepsis)