ETOH withdrawal as disallowed PDX?
Hello,
We seem to be seeing a scenario with increased frequency. I wondered if others had any input.
When I patient is showing signs of withdrawal and they are not able to go to the behavioral health floor for po meds and IM injections for detox/withdrawal (the location functions as separate admission- separate medical record number) because the patient requires a higher level of monitoring- IV push or telemetry,etc, , does your facility, or interpretation of any coding guidelines/coding clinic preclude you from sequencing alcohol withdrawal as PDX?
The coding clinic that is being cited uses an example of ETOH dependence and acute pancreatitis, saying that Acute pancreatitis should go first with alcohol dependence as secondary.
This has been interpreted as there must be a medical, non-ETOH related reason for PDX.
The part I am wondering about is the coding clinic references dependence NOT Withdrawal.
Having ETOH WITHDRAWAL hasn't been an issue for PDX in my past experience.
Thanks in advance for any input!
Below references provided by coding:
Per coding "...alcohol dependance/intoxication/withdrawal should not be PDX when patient is admitted to a Medical floor for a medical diagnosis that coincides with the alcohol diagnosis. The Medical diagnosis should be PDX and the alcohol diagnosis is secondary.
"Below are a couple of Coding Clinics giving the direction of coding the condition first then the alcohol code. The Principal diagnosis guidelines states when the patient is admitted with substance abuse/dependence and a physical condition, code first the physical condition, then the abuse/dependence code ."
Selection of the Principal Diagnosis
The designation of the principal diagnosis for patients with either substance abuse or substance dependence is determined by the circumstances of the admission, as defined in the following examples:
When a patient is admitted for detoxification or rehabilitation for both drug abuse or dependence and alcohol abuse or dependence, and both are treated, either condition may be designated as the principal diagnosis.
When a patient with a diagnosis of substance abuse or dependence is admitted for treatment or evaluation of a physical complaint related to the substance use, follow the directions in the Alphabetic Index for conditions described as alcoholic or due to drugs; sequence the physical condition first, followed by the code for abuse or dependence.
When a patient with a diagnosis of alcohol or drug abuse or dependence is admitted because of an unrelated condition, follow the usual guidelines for selecting a principal diagnosis."
Coding clinic first quarter 2020-p9
Coding clinic third quarter 2019--p8