Assignment of primary DRG

linda.brannon@lpnt.netlinda.brannon@lpnt.net
in CDI Management

I have been in the CDI role for about 2 yrs at my facility. Coders are on sight but different building. Trying to trend down number of mismatch" reports thru ChartWise.  My question: (scenario) Pt comes in with bleeding hemorrhoids, states black liquid stools for the past 4-5 days.( stool sample sent to lab-   NO occult blood)- Pt Hgb 6.7, Hct 20.1.   Pt receives 3 u PRBC's. No colonoscopy or eval per GI.    MD list as diagnosis:

acute blood loss anemia secondary to GI blood loss from chronic hemorrhoids.

Trying to understand how coders think ( I am a RN) so my thinking is along clinical lines)-  

Coding bills primary DRG as  Acute blood loss anemia

It is explained to me that if we "do not treat a condition" , then it is not coded- for example, IF GI Specialist had been involved with colonoscopy, evaluation, etc.... then GI hemorrhage would have been assigned the primary DRG.

As a nurse, Hard for me to wrap my brain around the fact that you can code Acute blood loss anemia  BEFORE acknowledging the reason the patient came to hospital, which was, bleeding from rectum, black liquid stool, abdominal pain  ( its like which came first, chicken or the egg?)

Can someone help me to understand this process better?  Would you have coded GI hemorrhage as Primary?

Open to information from educators, CDI, and coders!  

thanks in advance  Diaen Brannon RN/CDI STRHS- Lawrenceburg, TN 

Comments

  • jmccorkl@stanfordhealthcare.orgjmccorkl@stanfordhealthcare.org
    Yes, this can be tricky!  I understand how clinical (RN) reasoning and Coding practices can seem to conflict.   :p
    The source of the bleeding is documented as "chronic hemorrhoids" - which would not merit a hospital stay by itself.  It seems in this case that admission and treatment was focused on the blood loss anemia, so I agree with coder using the Anemia as PDx.  Hemorrhoids would be a secondary dx.
    Also, my understanding is that bleeding hemorrhoids (K649) do not equal GI hemorrhage (K922), so if hemorrhoids were the PDx (for example, if a procedure had been done on them) the DRG would be 394 - Other Digestive System Diagnoses w/ CC (*ABLA is the CC).

    Jeanne McCorkle, BSN, RN, CCDS

    P.S. Another ChartWise user!
  • Padawan5773Padawan5773

    For us that is a tricky one too. 

    I agree, I would have sequenced the anemia as PDx - because it appears the focus of care was transfusion for the anemia.  Your PDx is the condition chiefly responsible for admission to the hospital, after study. 

    I'm surprised GI did not get involved.  If GI did more such as EGD/Colonoscopy, medications (Octreotide/Protonix/Ranitidine), spec for H. pylori... etc, I would have sequenced K92.2 first. 

    I would still code the K92.2 as secondary if they haven't ruled it out by a statement of "possible" or "suspect".  I still have a hard time with anemia and neoplasms :-)


    Christopher Isobe, RN

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