What is the Principle diagnosis please?
I would appreciate some help please on this from my fellow colleagues.
52 year old male with COPD was having trouble at home when family heard him wheezing and trying to get his nebulizer hooked up and he collapsed.
The patient's brother called his mother who came down and at that point, she called 911. She had never given CPR before but the 911 instructors instructed her on how to do CPR and a unit was dispatched. The patient's mother did untrained CPR for approximately 10 minutes prior to arrival of the squad. When the squad arrived, they found the patient in asystole. They initiated CPR. They placed a King airway and started ventilating him and initially he had several runs of PEA and went through 4 rounds of epinephrine and CPR circuits and the patient gradually had of return of spontaneous circulation and subsequently arrived in the emergency room obtunded but with a heart rate of 138, a blood pressure of 138 systolic and hypothermic.
The inpatient coder has coded this as acute respiratory failure. I think the principle should be cardiopulmonary arrest. Thoughts??
Comments
Consider potentially reversible causes of Asystole and PEA (Hs and Ts):
■ Tension pneumothorax
■ Thrombosis (pulmonary or coronary)
■ Tamponade, cardiac
■ Toxins
I would appreciate some help please: Query technical issue question
In my hospital CDIS do interim coding. The question is, if the Inpt Coder requests the CDIS to initiate a query for him/her and the query fell through after the initiation as in the Dr never knew about the query, who is ultimately responsible for the query. The chart was final coded and it stated Dr never responded. Would this be the person who wrote up the Query to follow through though she did not interim code it, or would it be the Inpt Coder who final coded it.
This unanswered query was discovered through a delinquency report from the Dr.
There is a coding clinic that speaks to this scenario. The cardiac arrest should only be used as the pdx if the underlying etiology is unknown. See Coding Clinic Q1 2013-Cardiac arrest w/o underlying condition.
Cardiac arrest can be the principal or first-listed diagnosis if the underlying condition is not known. It does not matter whether the patient is resuscitated or not. The assignment and sequencing of code 427.5, Cardiac arrest, is dependent upon the circumstances of the hospitalization. If the patient is admitted due to cardiac arrest and an underlying cause is not established before the patient is discharged or expires, it is appropriate to assign code 427.5 as the principal or first-listed diagnosis. Code 427.5 should not be sequenced as the principal or first-listed diagnosis if the underlying condition is known. It may be assigned as a secondary diagnosis code when it meets the definition of a reportable additional diagnosis, regardless of whether the patient is resuscitated or not.