We received a denial for coding traumatic rhabdomyolysis on a patient who had documented rhabdomyolysis due to a fall. The patient had a fractured hip so the DRG was multiple significant trauma. That DRG didn't seem warranted on a patient with a fractured hip who went home in 4 days. We decided that traumatic rhabdomyolysis has be from a trauma, car accident, crush injury etc not someone who is found on the ground or who falls.
This is a strategy that we recently started to utilize at the facility I work out. The documentation must explicitly cite "traumatic rhabdomyolysis". If not, we utilize information found through UpToDate to support a query for traumatic rhabdo in which they reference 3 types of rhabdo:
-Traumatic or muscle compression (eg, crush syndrome or prolonged immobilization)
-Nontraumatic exertional (eg, marked exertion in untrained individuals, hyperthermia, or metabolic myopathies)
-Nontraumatic nonexertional (eg, drugs or toxins, infections, or electrolyte disorders)
This also provides a source that our Providers find legitimate and are more comfortable having an open dialogue with the CDRNs about this diagnosis now associated with patient with a prolonged down time prior to admission.
Not sure if the link will work for all, but I've placed it below.
I am not certain why you experienced the denial, but apparently the 3rd party indicated in the correspondence it was not documented as 2/2 trauma? If so, concur w/ thoughts previously expressed a query would be in order. See message from 'curveball' above.
Great thread. I was just talking to the coder about the appropriateness of doing a query for traumatic rhabdo. She seemed to think that I should do one for everyone that had the dx of rhabdo with any fall injury.
ICD10data.com defines these conditions as;
Rhabdomyolysis
Clinical Information
A
potentially fatal disease that destroys skeletal muscle
Necrosis
or disintegration of skeletal muscle often followed by myoglobinuria
Traumatic Rhadomyolysis
Clinical Information
A type of
permanent damage to muscles and nerves that results from prolonged lack
blood flow to those tissues. It is characterized by shortening and
stiffening of the muscles.
Comments
This is a strategy that we recently started to utilize at the facility I work out. The documentation must explicitly cite "traumatic rhabdomyolysis". If not, we utilize information found through UpToDate to support a query for traumatic rhabdo in which they reference 3 types of rhabdo:
-Traumatic or muscle compression (eg, crush syndrome or prolonged immobilization)
-Nontraumatic exertional (eg, marked exertion in untrained individuals, hyperthermia, or metabolic myopathies)
-Nontraumatic nonexertional (eg, drugs or toxins, infections, or electrolyte disorders)
This also provides a source that our Providers find legitimate and are more comfortable having an open dialogue with the CDRNs about this diagnosis now associated with patient with a prolonged down time prior to admission.
Not sure if the link will work for all, but I've placed it below.
https://www.uptodate.com/contents/causes-of-rhabdomyolysis
So far we have not experienced denials, but it's relatively new to the CDRNs to utilize this strategy.
Traumatic rhabdomyolysis was not documented. The rhabodomyolsis was r/t being found down for an unknown period of time.
I am not certain why you experienced the denial, but apparently the 3rd party indicated in the correspondence it was not documented as 2/2 trauma? If so, concur w/ thoughts previously expressed a query would be in order. See message from 'curveball' above.
ICD10data.com defines these conditions as;
Rhabdomyolysis
Clinical Information
Traumatic Rhadomyolysis
Clinical Information
What are your thoughts on these definitions?