Why is rectal tube placement moving DRG to surgical DRG?

renmeyer@sbcglobal.netrenmeyer@sbcglobal.net
in Clinical & Coding

Good morning.  Please help me understand this: Patient was admitted with sepsis, hyperammonemia, acute resp fx, pneumonia etc..  I had sepsis as pdx, DRG 871.  The coder left a note stating "pt had rectal tube placed in ICU...affects DRG".  Code 0D9P7ZZ was coded taking it to DRG 853. MD documented "rectal tube placed due to diarrhea possibly due to lactulose" in his progress note. Is this code correct for placing of a rectal tube due to diarrhea?  I have not seen this before and think if it is correct we are probably missing out on a lot of money for not coding it.  Thank you for you help!

Renee, RN, CCDS


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  • Debra.Clark@sanfordhealth.orgDebra.Clark@sanfordhealth.org

    After review of what you've shared, it appears that the drainage device is not included in the code.  Code 0D9P70Z, Drainage of Rectum with Drainage Device via Natural or Artificial Opening is what we established.  This is not considered a surgical procedure.  I hope that helps.

    Deb Clark, RN, BC, CCDS, Supervisor Clinical Documentation

  • morris-jeff@CooperHealth.edumorris-jeff@CooperHealth.edu
    Debra.Clark@sanfordhealth.org said:

    After review of what you've shared, it appears that the drainage device is not included in the code.  Code 0D9P70Z, Drainage of Rectum with Drainage Device via Natural or Artificial Opening is what we established.  This is not considered a surgical procedure.  I hope that helps.

    Deb Clark, RN, BC, CCDS, Supervisor Clinical Documentation


    I get the same code which wouldn't be considered a surgical procedure.

    Jeff

  • bbogda@morrishospital.orgbbogda@morrishospital.org
    Agree with Debra and Jeff.  It appears that if the drainage was done with 'no device' 'no qualifier' that leads to the 0D9P7ZZ (valid OR).   Drainage -> rectum ->via natural or artifical opening ->   WITH device gives the code as Debra states above.  (non-valid OR).
    Thanks,
    Betty
  • renmeyer@sbcglobal.netrenmeyer@sbcglobal.net

    To clarify, if a patient had a rectal tube placed for diarrhea only it would be coded as 0D9P70Z? 

    Thanks to everyone for your replies. So helpful!

  • lprescott1lprescott1
    The rectal tube is left in place to drain- then 0D9P70Z is assigned. This does not allow for a surgical DRG. The 0D9P7ZZ procedure, identifies that no device remained, interesting enough this does allow for a surgical DRG. The approach can also influence whether surgical- for example no device with a percutaneous endoscopic approach does move it to a surgical DRG- 0D9P4ZZ. There is no rhyme or reason. 
  • evanspx@sutterhealth.orgevanspx@sutterhealth.org

    Perhaps worth mentioning that a few years ago, insertion of A-lines was also impacting DRG assignment, as well as a couple of other PCS procedures....we issued some guidance on this per ACDIS, after sending communications to several key parties.   One theory is that these assignments represented a mapping error in the DRG trees of the time. 


    Paul

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