PSI 09 Fall out
I was looking at a PSI 09 fallout. I think there were definite potential queries that could have been asked to make clear but that window has closed.
Thoughts on these two questions:
- I was wondering, why thrombocytopenia due to cirrhosis was not considered an exclusion but , unspecified or primary thrombocytopenia was an exclusion. what would be the rationale?
- Also the patient came in ( unplanned) on Coumadin( valve) with an INR of 2.5, they held the Coumadin for a few days, and INR was 1.5 the day they took the patient to the OR for a hernia repair. immediately post-op they started IV Heparin. The next day, the patient developed a hematoma.
Based on the coding clinic below I inquired, if the following documentation was sufficient to code D68.32 ), without a query. But was told no. :
Day of surgery 8-11-
“Long-term anti-coagulation with the Coumadin secondary to mechanical aortic valve heparin gtt transition to Coumadin post op”
8/12-
“Long-term anti-coagulation with the Coumadin secondary to mechanical aortic valve
heparin gtt on hold sec to hematoma”
Question:
Should bleeding due to therapeutic anticoagulant be coded as a hemorrhagic disorder (category D68)?
Answer:
For the most part, "hemorrhagic disorder" or "coagulation defects" must be specifically diagnosed and documented by the provider, in order to assign codes at category D68, Other coagulation defects. However, for bleeding such as hemoptysis, hematuria, hematemesis, hematochezia, etc., that is associated with a drug, as part of anticoagulation therapy, assign code D68.32, Hemorrhagic disorder due to extrinsic circulating anticoagulants. This is supported by the inclusion term at D68.32 of "Drug-induced hemorrhagic disorder."