Hypovolemic Shock & Dehydration
Curious to hear from both nurses & coders that may follow this forum. It was brought to our attention that there is an Excludes 1 note that says the E860 (Dehydration) should never be used at the same time as R57.1 (hypovolemic shock). Is anyone else surprised by this? Clinically, that doesn't make sense to me, since dehydration doesn't capture the same severity of illness as hypovolemic shock does. From the coding perspective, they say that since hypovolemic shock is an "R" code, a sign/symptom code, that it should not be coded in addition to dehydration. By this same argument (just being devil's advocate here) we shouldn't be able to code Severe sepsis w/ shock either, as that's also an R code (although sepsis does not include the same excludes note). Can anyone provide any articles, coding clinics that discusses this phenomenon as well?
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I agree. That does not make any sense. I think the definition of excludes 1 is a little misleading. The way it reads, it sounds like you should not code anything in the excludes 1 red box. However, based on these two coding clinics, the code within the excludes 1 red box is the code that should be coded and not the one above.
Nontraumatic acute liver injury ICD-10-CM/PCS Coding Clinic, Second Quarter ICD-10 2015 Page: 17 Effective with discharges: July 6, 2015
This states in a patient with acute liver injury as well as acute non-viral hepatitis, to code K72.00 Acute and subacute hepatic failure without coma. The excludes 1 note at K75.9 Inflammatory liver disease, unspecified instructs us not to code K75.9 if K72.0 has been coded.
Intestinal obstruction due to peritoneal carcinomatosis ICD-10-CM/PCS Coding Clinic, Second Quarter ICD-10 2017 Page: 12 Effective with discharges: May 17, 2017,
This states to code C78.6 Secondary malignant neoplasm of retroperitoneum and peritoneum and not K56.60 Other and unspecified intestinal obstruction as instructed by the excludes 1 note at K56.6.
Also, there is a great ICD 10 monitor article that helps explain how excludes 1 should be used.
https://www.icd10monitor.com/healthcare-industry-turns-attention-to-gender-identity-dysphoria-in-wake-of-teen-s-suicide?highlight=WyJleGNsdWRlcyJd
Based on the above, if you are looking at a code with a red excludes1 note below it, it appears that you code only what is in red and exclude the code above it.
Hope this is helpful.
Wow. Although I admit that it took me a couple times looking at, I'm beginning to understand what you mean. Although I've been in CDI for 6 years now, some coding issues can really confuse me! I'm setting a letter to Coding Clinic to clear this up, but wanted to hear from my peers as well. Thank you so much for relaying this information to me.