Coding HIE in a child older than 28 days old
We would like feedback as to how others are looking at HIE in a child older 28 days old. Below is the scenario we have.
Patient who is 13 years old presents with documentation stating,
With HIE and subsequent spastic quadriplegia, epilepsy, dysautonomia, OSA (baseline nighttime BIPAP 16/8 BUR12), factor vii and xii deficiency, as well as thoracolumbar scoliosis who presents with acute on chronic hypoxemic respiratory failure.
Question:
Should HIE be coded as HIE with residuals, Anoxic brain damage with residuals, other encephalopathy with residuals or just the residual effects of the HIE?
Thank you!
Irene Lovano RN, CCDS
Comments
I can't find anything specific to this situation, but based on coding guidelines, I would continue to report the HIE since "Should a condition originate in the perinatal period, and continue throughout the life of the patient, the perinatal code should continue to be used regardless of the patient’s age"
I would also report any residuals/current issue the patient has.
The spastic quadriplegic cerebral palsy is the manifestation of the initial insult at birth. The HIE is an anoxic brain injury. Cerebral palsy, anoxic brain damage...