BAL Diagnostic vs No Qualifier

jmccorkl@stanfordhealthcare.orgjmccorkl@stanfordhealthcare.org
in Clinical & Coding
Does anyone understand why a pt in DRG 004 moves to DRG 003 if a BAL was done and coded as "no qualifier" but stays DRG 004 if BAL is "diagnostic"?  Same procedure to the patient, just different in what is done with the stuff removed.
Thanks!
Jeanne McCorkle BSN, RN, CCDS

Comments

  • ramu31pharma@gmail.comramu31pharma@gmail.com
    jmccorkl@stanfordhealthcare.org said:
    Does anyone understand why a pt in DRG 004 moves to DRG 003 if a BAL was done and coded as "no qualifier" but stays DRG 004 if BAL is "diagnostic"?  Same procedure to the patient, just different in what is done with the stuff removed.
    Thanks!
    Jeanne McCorkle BSN, RN, CCDS

  • ramu31pharma@gmail.comramu31pharma@gmail.com
    Hi,
    The reason behind this , we have to identify and conclude the procedure report to get main objective of of BAL. Whether it is diagnostic or therapeutic.  Basically BAL  involves washing of alevloi , a diagnostic procedure involves collecting sample of cells. when the objective of the procedure it to wash entire lung it would be coded to therapeutic with out qualifier. Approach is main concern for taking DRG as OR procedure. I am expecting In your DRG procedure was done as open for entire washing of lung.
  • afrady@blr.comafrady@blr.com
    Can you provide the exact diagnoses and procedures used to get into DRG 004 at the outset?
  • jmccorkl@stanfordhealthcare.orgjmccorkl@stanfordhealthcare.org
    J10.00 Influenza, POA
    R65.21 Sepsis w/ Shock, not POA
    0B113F4 Trach
    5A1955Z Vent >96 hrs
    (and many other codes not affecting DRG)

    BAL: 0B9J8ZX vs 0B9J8ZZ
  • RPinson@PinsonandTang.comRPinson@PinsonandTang.com
    If BAL is diagnostic (any sample sent for analysis) assign code 0B9J8ZX. If no sample is sent, BAL is a therapeutic only (typically for thick impacted secretions) and assigned code 0B9J8ZZ (an OR procedure leading to a surgical DRG).

    Richard D. Pinson, MD, FACP, CCS
    Pinson & Tang
    CDI Educators and Advisers
    Authors of the CDI Pocket Guide
    www.pinsonandtang.com


  • lprescott1lprescott1
    I would caution that just because a sample is sent does not mean it was diagnostic. The bronchoscopy can be performed for therapeutic purposes and while "in" samples or washings can be obtained. If the true purpose of the procedure is not clear, the provider should be queried. 
  • Sharme.Brodie@hcpro.comSharme.Brodie@hcpro.com
    I agree with Laurie as someone who has been involved with many of these procedures, if you are not sure query the provider.
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