CHF vs Pneumonia as PDx
Looking for thoughts on what you would use for PDx. Patient is 72 y/o with severe cardiorenal syndrome. He brought in by EMS after found unresponsive and hypoxic at home. He was admitted with Acute Systolic CHF and probable pneumonia. The pulmonologist documented acute respiratory failure due to chf and pulmonary edema. The attending is documenting acute respiratory failure due to acute systolic chf, and pneumonia. The patient was intubated and on ventilator x 4 days, treated with rocephin, zosyn, azithromycin, augmentin and treated with cardizem gtt, aminodarone, diuretics and also with vasopressors for cardiogenic shock. In this case, do you think either pneumonia or CHF could be assigned as PDx?
I believe you have sequencing choice as both were present and were worked up and treated 'aggressively".
Particularly noteworthy that both caused acute organ dysfunctions that increase mortality - the PNA causing the ARF and the CHF causing Shock. For me, because the scenario stated that both processes caused these acute organ dysfunctions, I feel that there is a sequencing choice in this scenario.
Paul Evans, CCDS
It is also noteworthy that cardio renal syndrome will get you an I13 category code and you will actually get hypertensive heart and kidney disease the actual code for that description.
Whenever there is pneumonia, heart failure(I am refusing to use "CHF" anymore) and respiratory failure all causing an admission, the sequencing should depend upon the individual clinical indicators and treatment rendered for the final determination. Each of the 3 processes will have to be looked at...IE, mild CHF, plus severe pneumonia plus rapid recovery from respiratory compromise would likely get you a pdx of pneumonia. Mild pneumonia plus severe heart failure plus respiratory compromise cleared with diuretics would likely get you a pdx of heart failure. Both mild heart failure and simple community acquired pneumonia (neither of which appear impressive by themselves) but with respiratory failure requiring admission would likely get you a principle diagnosis of respiratory failure. ...THAT is what coding clinic means by "the circumstances of admission govern the selection" here.
Per the guidelines, there is no "one answer" for this scenario and I would encourage you not to place any faith in anyone who insists there is.
Agree w/ Allen. There is no easy 'one answer' for such scenarios. I am glad to see we have such conversations on complex topics. Anyone that tells you that coding is 'easy' or that there are easy answers...my advice, run away from them as fast as possible.
I know it is splitting hairs and that questions always induces eye rolls from doctors but that is how the reporting works (don't shoot the messenger).
But, this does not negate that one may issue a query in order to discern precisely what you state above. ARF with PNA may equate to severe sepsis, or perhaps not. I believe this would warrant a well-crafted query.