Rhabdomyolysis

debra.stewart@halifaxregional.comdebra.stewart@halifaxregional.com
in Clinical & Coding
Looking for input about coding Rhabdomyolysis.  Patient admitted with Acute Rhabdomyolysis s/p fall. laying in floor for hours, son finds patient brings to ER.  Admit Diagnosis of acute rhabdomyolysis.. How would you code this?  as traumatic Rhadomyolysis or simple rhabdomyolysis (other) which codes to "tendonitis/myositis/bursitis".  Being Rhabdo is caused usually by trauma, (muscle damage) I have used traumatic rhado if the patient has documentation of a fall.  ???

Comments

  • kbalogunkbalogun
    Query . . .  what you are doing is up-coding.  In my days as an auditor, I overturned many a case like yours!

    Trauma has specific definition. When in doubt, query!. You are not to bring your personal/subjective/emotional feeling. Be logical and honest

     Providers document, CDIs clarify, coders transform words to codes. Please be careful and ethical. FRAUD IS NOT GOOD
  • don.cdi.rn@gmail.comdon.cdi.rn@gmail.com
    Agreed.  If the pt fell, was admitted and then developed rhabdo was probably trauma related.  Pts who spend hours on the floor immobile have other likely reasons for the rhabdo developing.
    In any case, if not clearly stated by the MD for the underlying cause, query.
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