CDIFF question?
Hello,
Would you query on the below for clarification or what would you code? We are getting different opinions from coders, CDS, and the outside external reviewer who reviewed the case.
Patient treated with Flagyl.
Labs and a consultant say the following: C. Diff present but toxin not detected indication colonization with non-toxigenic strain or level of toxin is below detectable levels but since patient is still having diarrhea will continue to treat with flagyl for now.
What would you do?
Thanks for your assistance.
Kim
Would you query on the below for clarification or what would you code? We are getting different opinions from coders, CDS, and the outside external reviewer who reviewed the case.
1. Acute C Diff gastroenteritis
2. Diarrhea secondary to acute gastroenteritis with negative Clostridium
difficile toxin and positive antigen.
Patient treated with Flagyl.
Labs and a consultant say the following: C. Diff present but toxin not detected indication colonization with non-toxigenic strain or level of toxin is below detectable levels but since patient is still having diarrhea will continue to treat with flagyl for now.
What would you do?
Thanks for your assistance.
Kim
Comments
Laura Bohls, RN
Prairie Lakes Healthcare System
On first glance I'd say code the C.Diff based on the description of it as "present" and just being a non-toxigenic strain. Is that specifically documented this way in the record? What does your attending say about the lab results? He needs to confirm the diagnosis.
Erik J. Kilbo, RHIA, CCS, CPC-I, CDIP, CCDS
Enterocolitis due to Clostridium difficile
It doesn't further specify the presence of absence of a certain strain or type.Was the patient evaluated, treated, tested, had their stay extended or increased nursing services for this diagnosis?
Which test was sent? The ELISA for antigen, the ELISA for Toxin, the PCR for toxigneic genes or the Cytotoxin Assay?
It looks like maybe you got one positive test for the ELISA antigen and one negative test for the ELISA toxin. If the antigen was positive they have C. Diff.
The ELISA for toxin is known to have a super high rate of false negative tests.. Up to 75% of the time you can get a negative test for this even when the C. Diff is present
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4324208/
Because of the lack of clinical expertise by the average coder or even CDI do not..i repeat do not..make coding determinations based on lab results while ignoring physician documentation.
If the patient is having symptoms the odds are significantly reduced that they are actually nontoxigenic unless there is a named alternative cause to explain the diarrhea some where in the record.
Even if you disagree remember the rule for uncertain diagnoses at the time of discharge. It is reported on the grounds that the initial therapeutic response and plan of care for suspected is identical as for confirmed diagnoses and at it's heart, ICD 10 and DRG's are more about measuring the resource utilization than they are about always getting the clinical truth correct (the flip side of that argument is part of the rationale for denying malnutrition and rapidly resolving kidney failure by the way).
If it were established as non-toxogenic however, the patient would be expected to be 1) asymptomatic, 2) not be receiving treatment and 3) Not meeting reportability under the UHDDS.
Of those criteria above, you are meeting none.
https://ebm.bmj.com/content/21/2/67
https://www.frontiersin.org/articles/10.3389/fmicb.2018.01700/full