Cardiac arrest hours after admission

Lynn.heinrich@va.gov

Patient arrived in the ED @ approximately 23:00 with chief complaint of fall earlier in the day. Also complains of worsening dyspnea.  CTOH is negative.  Besides the fall, H&P identifies Hypoxic respiratory failure with worsening SOB / Possible CHF / AKI / etc..  Alert and oriented on admission.  Admitted as an inpatient to a medical floor at ~03:30.  Patient arrested at 05:45, resuscitated, transferred to ICU.  Died a short time later.  Death summary notes primary diagnosis as Cardiac Arrest.  

Our coding team identified "Cardiac arrest, cause unspecified" as the primary diagnosis.  They indicated that "after study" this was the diagnosis that was the cause for the patient to be admitted. 

Given the fact that patient was alert and oriented at time of admission and didn't arrest until several hours later, should the cardiac arrest drive the diagnosis or would one of the other initial diagnosis from the H&P drive the diagnosis. 

Thoughts and comments really appreciated!

evanspx@sutterhealth.org

Brief response to a complicated issue: but, clearly the arrest is not the principal diagnosis in the scenario you describe as it was not present on admission and happened hours after the admission for other acute events.    Clearly, one of the ‘other’ diagnoses you note would be the principal diagnosis and it is not logical or possible for the arrest to be the principal diagnosis.   
Paul Evans, RHIA, CCDS

Lynn.heinrich@va.gov

Thanks Paul!  

morris-jeff@CooperHealth.edu

Agree with Paul, the cardiac arrest did not occasion the admit since it did not happen until ours after the admission. I would sequence the most acute/resource intensive dx as the PDX.

Jeff

jillian.bisbe

Agree. I only see cardiac arrest as the pdx if that is what the patient presented with (cardiac arrest in the field or similar) and underlying condition is unknown.