Stroke due to Sickle Cell Disease

Need some assistance in the principal diagnosis of a patient who is admitted with a stroke due to sickle cell disease.  The physician noted that the patient is not in sickle cell crisis.  Focus of documentation is on the stroke with hemiparesis.  The patient has had two exchange transfusions.  Is the principal diagnosis the stroke, the acute condition or the chronic sickle cell disease.  

Thanks!  Karen

Comments

  • edited January 31
    Do they have Moya Moya?  I do believe our coders code the type of stroke, the Moya Moya and then the hgb ss disease (rarely hgb sc).  also, any significant illness in hgb ss is treated with plasmapheresis to try to remove the sickle cells
  • I would code the stroke as PDX
  • Thanks Val and Jeff!   Appreciate the responses.  And, while I initially agree with Jeff, my coders selected the sickle cell anemia w/o crisis as the principal diagnosis.  As they felt that the stroke was a manifestation of the sickle cell.   And, after another careful review of Coding Clinics, I now agree that sickle cell is the principal diagnosis (not that I agree with coding clinic-but they over rule me). 

    Coding Clinic supports sickle cell anemia as the  principal with acute chest, splenic sequestration, admission due to hemochromatosis due to repeated blood transfusions.  So, it follows that the principal diagnosis should be the sickle cell anemia in patients who have had a stroke due to sickle cell anemia. 

    Thanks, Karen 

  • I agree with the advice from Coding Clinic on the sequencing of those conditions but I am still on the fence about the PDX for a patient with stroke due to sickle cell dz. I think it would be good to write them and get some official advice. Also I would be interested in hearing how other Pedi hospitals would sequence. I am just thinking that sickle cell not in crisis for PDX really isn't representative of the acute condition occasioning the admission.
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