Coding Subdural Hematomas

jpotter

How would you code the following scenario?
A Pt. has an admission for traumatic subdural hematoma. Also has atrial fib and out pt coumadin therapy was begun when hematomas were stable with strict parameters for INR. Pt re-bled and was re- admitted with the following statement in the H+P. "Recurrent subdural hematoma. Likely second to prior injury and restarting coumadin." Coding clinic 1990 3Q directs the traumatic subdural hematoma as the pdx. Can subdural hemorrhage 432.1 be listed as a secondary code with an E code for adverse effect of coumadin? The 432.1 would be an mcc. Janice Potter R.N. CDI

david.smith

I would just code the traumatic subdural hematoma since it appears that the current problem is really just an extension (continuation) of the prior injury. I wouldn't code a non-traumatic SDH unless there was something very concrete in the documentation stating that there was a new (nontraumatic) SHD superimposed on the prior traumatic SDH. I think the coding of both a traumatic and nontraumatic SDH on the same admission both with POAs of "Yes" would appear strange. Interestingly, the definition of code 852.2x is for "subdural hemorrhage after injury,.." but there is no qualification of the timeframe post-injury so I think the initial bleed and/or extension of the bleed following the injury would fall under this code.