DNR, PEA arrest and In-Hosp Complications
We are experiencing a problem with patients who are DNR (orders in the chart) and providers documenting PEA arrest? The arrest hits our In-Hospital Complications list. It doesn't seem right! Thoughts?
Suggestions greatly appreciated.
Sue
Comments
From the limited background offered, it is a bit difficult to offer advice...But, it 'sounds like' perhaps your site may be coding PEA arrest for all cases that expire? Or, if not, perhaps coding the PEA when it should not be coded. Perhaps review with the coding manager the coding guidelines around PEA as these limit the coding of PEA to limited circumstances. There are specific reporting instructions for arrest in the Official Coding Guidelines.
Paul Evans
CCDS
Thank you Paul and Sharme for your input. It is a question that has been floating around our multi-facility organization with varying interpretations on how it should be coded.
Pt is DNR. PEA noted, CPR not performed, death occurs and it is coded as cardiac arrest.
There are very specific rules re: how/when PEA and arrest may be coded and I suggest you may wish to review those with the Coding Manager. The rules are too voluminous to copy in this forum. From the brief descriptions cited, it 'sounds like' your site may be coding cardiac arrest with each expired patient, which is not permitted. I can't be sure and would need more context. We can code cardiac arrest, for instance, if it occurs and there is no explanation for 'why' it occurred...this should be an exception rather than a rule. The coding rules also permit coding in a few other select instances. The coding rules are very specific about this situation, and the coding team should have no confusion around this and there is really not much room for interpretation - there should be a uniform policy and understanding around the circumstances of how/when cardiac arrest should be coded.
I am trying to copy and paste some of the rules around this for you, but for some reason, I can't get the paste feature to respond in this forum.
Paul Evans
CCDS
PEA is exceedingly rare as a cause of death. When working in cardiac oriented units, I witnessed PEA arrest maybe once or twice a year.
For PEA to occur, you must have normal heart conductivity without a pulse. This only occurs in conditions such as cardiac tamponade, profound hypovolemia, severe acidosis, massive PE, Tension pneumo, etc. All rare for in hospital deaths (some are more common for community acquired and death in Emergency rooms). The most common cause (about 50%) is from hypoxia and respiratory failure, in which case, you should most likely not be reporting PEA as it would be integral (routinely associated with) the final course of death from respiratory failure. Cardiac arrest as a result of respiratory arrest isn't necessarily reportable if it is an expected and known outcome which is not separately addressed. In some rare cases when it the PEA itself has been identified as being present and is separately evaluated, monitored, treated etc. it may be reportable as an additional diagnosis.