CF

lnsavage10@yahoo.com

Needing help understanding appropriate coding for patients admitted for "CF exacerbation" and started on IV abx for h/o MRSA and pseudomonas. What do you code? What do you query?

~Leah Savage, MSN, RN, CCDS

Norton Children's Hospital

Louisville, KY

morris-jeff@CooperHealth.edu

Hi Leah, 
We usually look at the indicators & any diagnostic workup & then ask if they are treating pneumonia or bronchitis if on adequate course of antibiotic therapy. Also query for type of CF manifestations: 1) pulmonary, 2) GI 3) Both...I think these will add an mcc vs. cc for plain ole CF!
PDX should be the infection they are treating.

jeff 

cmclose@saintfrancis.com

Hi Leah.

I agree with Jeff.

Generally here where I work the Pdx is acute bronchitis as our pulmonologists 99% of the time say the CF pt is being admitted for "acute exacerbation of chronic bronchitis". (Very rarely do they say pneumonia.) So most of our CF pts fall under DRG 202 with MCC of CF w/ pulmonary manifestation.

There was one time where I sent a query to clarify the bronchitis dx in regards to the CXR showing "bronchiectasis" (which would have shifted the DRG to 190 I believe) but the attending disagreed and said "acute on chronic bronchitis".

Good luck.

Claudine

jackietouch@aol.com

Always tricky for us as well, especially when they document "admitted for CF tune-up" (as if they are at a Jiffy Lube). I agree with Jeff and Claudine: We look for any type of indicators and treatment for active infection and clarify from there, using active infection as PDx and CF with pulm/GI manifestations as secondary diagnoses. If no active infection is confirmed, we use the CF code (not the ideal situation, but happens).

Happy Thanksgiving all!
Jackie

lnsavage10@yahoo.com

Thanks everyone! This all is what I was thinking just wanted to make sure I wasn't missing anything.