TPA given @ time of admission for CVA
Our coders do not code TPA (procedure code 99.10) given in our ED when a patient is admitted to our facility. They say there is some coding rule, but I cannot locate this. We use 3M as our grouper, but while there is a question asking if TPA was given in another facility 24 hours prior to admission, there is nothing that speaks to use in your own facility. When I enter 99.10 for use of thrombolytic, the DRG is driven to DRG family 61 - which seems more accurate than DRG family 64 (as pt did receive was use of thrombolytic). Does anyone else have this problem? or know of some coding clinic that speaks to whether 99.10 can be coded when given in your facility?
Thanks much,
Becky Mann, RN, CDS
Queen of the Valley Medical Center
Napa, CA
Thanks much,
Becky Mann, RN, CDS
Queen of the Valley Medical Center
Napa, CA
Comments
I do not agree with not coding the 99.10 for administration of TPA in your ER.
Coding of Circulatory System Diseases and Neoplastic Diseases
24 Diseases of the Circulatory System
CEREBROVASCULAR DISORDERS Pages: 342-343
CEREBROVASCULAR DISORDERS
Code 434.91 is assigned for an aborted CVA when there is no further
specification as to the type of CVA. Patients who present with symptoms of
an acute cerebrovascular infarction and are treated with tissue
plasminogen activator (tPA) have actually suffered a cerebral infarction.
Although brain damage may not be demonstrated by CT scan, brain damage
would be visible microscopically. The administration of tPA is coded to
99.10, Injection or infusion of thrombolytic agent. It is effective in
treating ischemic stroke caused by blood clots that are blocking blood
flow to the brain. It is also effective in treating myocardial
infarctions.
Code V45.88 is assigned as an additional code along with code series
433-434 (with a fifth digit of 1), or with code series 410.00-410.92. Code
V45.88 captures the information that the patient is status post
administration of tPA at a different facility within the past 24 hours
prior to admission to the current facility.
Each component of a diagnostic statement identifying cerebrovascular
disease should be coded unless the Alphabetic Index or the Tabular List
instructs otherwise. For example:
Thank you,
Susan Tiffany RN, CDS
Supervisor
Clinical Documentation Program
Robert Packer Hospital & Corning Hospital
570-882-6094 pager 465
Fax 570-882-6768
Tiffany_Susan@guthrie.org
I agree, we also code anytime TPA is given regardless of the location or status of the patient. As a matter of fact when this DRG change occurred, our Stroke Coordinator used to email me any patient that rec'd TPA to be sure we reflected in coding to capture the reimbursement. I've not been able to pinpoint the reference but will keep looking as time allows.
Kari L. Eskens, RHIA
BryanLGH Medical Center
Coding & Clinical Documentation Manager
Thank you,
Pearley Bautista, RN, CCS
Enterprise Medical Coding
Ph: WW (310) 825-4777 SM (310) 319-4288
Fax (310) 825-1174
PBautista@mednet.ucla.edu
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I was just thinking that you could ask your coding staff to pose the question on the AHIMA Coding Community of Practice, if they don't agree and would like to hear from what others in the coding profession are doing?
I still haven't found a reference for you.