Readmission diagnosis

ssimmons@wyomingmedicalcenter.org

I attended the CDI for Quality boot camp, and our CDI department is working on a process to review charts that may fall into the readmission bucket.

My boss, who is the Chief Compliance officer wants more information.

Are there any written guidelines out there that CDI/coding would pick the non-readmission diagnoses as principle, if there are 2 diagnoses on admission that are treated equally?

This is in comparison to the coding guideline: If two diagnosis are present on admission, and treated equally, either can be coded as the principle diagnoses. It is acceptable practice to code the highest paying DRG.

Is it acceptable practice to choose the non-readmission diagnoses for the principle?

Thank you for any information you can provide.

sburkeinbeverly@yahoo.com

Excellent question !  While I have not attended the Quality bootcamp, nor do I work under the Quality umbrella but I do -in an "offshoot fashion"- have a loose link to those looking at Acute Care Sensitive Conditions and Re-admissions.   A recent discussion made me think in a same/similar way you did. 
If an admission occurs with 2 diagnoses that fit the definition of a PDX (both POA and treated equally during the IP stay), the "Coders Choice" rule of thumb comes into play where the coder has the ability to chose the one most advantageous to the situation (sometimes that might mean for reimbursement purposes, sometimes for LOS or RW).     Although it would likely not be terribly common/frequent occurrence, it could prove to be advantageous for ACSC / re-admisson purposes. 
What are your thoughts on this?  I am hoping for a lively discussion!

lprescott1

Interesting question. I teach the quality Bootcamp (I hope you enjoyed it)! I will say use caution in such an approach as you treading on a line of compliance. I would never formally write a policy that states to sequence the diangosis that does not trigger the quality measure. That said you may be able to do so in that rare occurrence in which both diagnoses equally contribute to the admission. My word of advice would be first evaluate that both equally contribute to the admission- remember the definition of PDX- That condition after study, found to have occasioned the admission. My second piece of advice is if you have choices, there are a number of factors that should be considered- would either diagnosis actually lead to an inpatient admission? resource consumption should be considered but is not the only driving force, as well as reimbursement. Each case is unique and there are times when you might be able to choose the diagnosis that wont trigger the quality measure- but there may be times when you need to choose it. 

ssimmons@wyomingmedicalcenter.org

Thank you both for you insight. It certainly helps to have the knowledge of others.

The Quality bootcamp was an incredible learning experience.

Thank you again.

lprescott1

I am so glad you enjoyed. that is one of my favorite courses to teach.