Epistaxis vs Nasal Fracture

bbogda@morrishospital.org

Patient fell face first onto floor and fractured her nasal bones bilat and had an additional fracture through the anterior osseous nasal septum,  She had epistaxis.  Localized pressure did not stop the bleeding, therefore she required bilat nasal tamponade with balloons.  It was documented that she was admitted to monitor airway due to the bilat balloons.  The discharge summary lists both the fracture and the epistaxis in list of diagnoses and states:  "The patient was monitored over the next 2 evenings due to her trauma as well as bilateral nasal packing.  The patient did  well without any evidence of respiratory issues."

Our coder wants to sequence the fracture of the nasal bones as PDx because 'they usually don't code the bleeding at a fracture site".   Thoughts?

Thank you,

Betty

evanspx@sutterhealth.org

What are you advocating as an alternative diagnosis.  Epistaxis is a sign, symptom, feature of nasal fracture.  From the brief scenario provided,  fractures are the Principal Diagnosis; although I’d ask how a patient passed criteria to admit with nasal fractures.   Some may advocate for observation rather than admission.  

bbogda@morrishospital.org

Paul,
I was advocating for the epistaxis as PDx since that was what prompted the admission and what was treated.  Had this been a nasal fracture with simple bleeding, I would understand the rule for coding fracture over bleeding as that is a sign, symptom or feature of the fx, and that patient would not have been admitted.  But I feel this case goes beyond that scenario. The hemorrhage being treated and monitored was why she was admitted.  Her airway was compromised by the treatment (balloons) and the doctor stated she needed admission for monitoring and treatment.  The epistaxis was potentially life threatening.  That's why I am having a hard time with this, but I understand that rules are rules.

evanspx@sutterhealth.org

Thanks, but 'epistaxis' is assigned to Signs and Symptoms category; not to be used if/when cause is known.  For that reason, I'd think the coding staff would not use it as the Principal Diagnosis. So, I'd use the fractures as PDX and also assign the bleeding as a secondary if was severe and out of the norm.