Suicidal Ideation

Hello. Would like to hear how other facilities are coding cases where patients are admitted for Suicidal Ideation (SI).

For a pt admitted for SI and no diagnosis of a mental illness (ie depression, bipolar, etc.) I can see how Pdx is SI.

However, we get a lot of teens admitted with SI (due to lack of beds at local Behavioral Health facilities) and these teens have psychiatric diagnoses also- some may or may not be on psychiatric medications at home and/or while in hospital. Some stay for a day, others are inpatient for a week while awaiting placement and we are treating them with 24 hour observation with a sitter, suicide precautions. Pt may or may not get a Psych consult done. Focus of care is keeping the pt safe while finding an inpatient psych facility/behavioral health facility for the pt to be transferred to.

Coding Auditor says any patient admitted for SI who has an active psychiatric diagnosis (such as depression, bipolar, etc. where SI can be a symptom of that dx), then the Pdx is the psychiatric diagnosis and SI is a secondary dx, whether pt is receiving any kind of psychiatric med (i.e. antidepressant) at home &/or inpatient. Auditor bases that on coding guideline regarding signs & symptoms.

There has been quite a bit of debate here between CDI, coding and the coding auditors regarding these patients. What are your thoughts? How are these types of cases being coded at your facility?

Thanks in advance!

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Comments

  • I think the Psychiatric dx should be the PDX as SI is most likely a manifestation of the underlying Psych dx. 
    Jeff
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