MI POA?

dong.li

hello, everyone, good morning,
i have a case here, patient came at night, with sob, mild resp failure, ER found pna, Cardiac enzyme at night of day one was negative, and day 2morning, troponin elevated, cardiac consult done, stated MI.
i am not sure if MI should be the pdx.

thanks all in advance!

catladyrn

Sounds like, based on the little you have, that it developed after admission. If the PNA was the reason for the admission, you could take the MI as a secondary dx/MCC.

I think you need more than just the ER record and a cardiac consult to determine what the reason for admission was. What is the attending saying? SOB and respiratory problems can result from either respiratory or cardiac causes. You need more documentation and then if it's unclear, you could query as to whether the MI was the principal diagnosis, although it seems unlikely if the first troponins were negative. However, of course, if the final decision as to principal diagnosis goes into the circulatory MDC, the MI, even if not pdx, will drive the DRG as long as it stays medical and not surgical.

You don't have to try to outrun your physicians to the diagnosis.

Renee


Linda Renee Brown, RN, CCRN, CCDS
Certified Clinical Documentation Specialist
Banner Good Samaritan Medical Center

david.smith

Hi,
I think you would definitely have to get a POA determination from the doctor in order to use the AMI as Pdx. It is possible that the MI was so recent that the Trop I didn't bump as of the 1st test (NIH states levels normally rise within 6 hours of MI). If it is determined that the MI was POA, then it could be used as the Pdx.

Unknown

Mei,

Do you have any other indicators for MI?
(EKG changes?)

If you have other indicators you could query for POA status.

Charlene

dong.li

Thanks for reply, I have very little in the record, no mention any chest pain or others in progress note and nursing notes, er notes, no EKG at the first day, only sob, and mild resp failure, pna, I will definitely try to talk with the attending to get clarifications, thank you guys for all the helps!!!!

dbutler

Another factor to think about -- sometimes individuals with Sepsis will have a troponin leak (not an MI due to CAD, something our cardiologists will differentiate between....ie, was it a type II MI, or a troponin leak secondary to various chemicals released related to the sepsis process). Are there clinical indicators for sepsis? You do have the infection, as well as 2 organ systems affected (cardiac & mild resp failure).

Don

Unknown

Has the Pneumonia been established as a diagnosis? Could the patient have been in heart failure from the MI?

I agree you may have to let this one unfold just a bit more to establish the POA. I would just ask the physician to clear up the events.

NBrunson, RHIA, CCDS