Cardiac Arrest

dvitalone1

We are having a discussion about when to code cardiac arrest as a secondary diagnosis. Our Coding Supervisor states that when a pt is admitted, cardiac arrests and dies code 427.5 is not coded. But, if the pt is admitted, cardiac arrests during admission, survives but dies later in the same admission we can use code 427.5 The other CDI Specialist and myself don't care whether it is a MCC or CC but we do think it should be coded to capture to resources utilized. What are your thoughts. We read the coding clinics. Maybe we are missing something? Thanks for your input. Dawn

michele.goossen

Cardiac Arrest 427.5 is not an MCC if the pt expires. Do not use it as a PDX if an underlying etiology is known and do not code it if the physician documents cardiac arrest to indicate the patient's death when the underlying cause or contributing cause of death is known.

See coding clinics 2nd Q 1988 pg 8 & 3rd Q 1995 pg 9.

Michele Goossen, RN, BSN, CHCQM
Clinical Documentation Specialist
Lakeland Regional Medical Center
863-687-1369

dvitalone1

I already know that info but thanks!


Dawn M. Vitalone, RN

angelamckee@uh.org

Your coding supervisor is referring to coding guidelines for cardiac arrest published in Coding Clinic second quarter, 1988 page 8.  My interpretation is slightly different, in that the only time cardiac arrest is not coded is when it isdocumented as the cause of death. (my opinion)  See below:
 Cardiac arrest - guidelines
      Coding Clinic, Second Quarter 1988 Page: 8   
Cardiac Arrest, 427.5
 
Code 427.5, Cardiac arrest (excludes that with pregnancy, anesthesia overdose or wrong substance given, and postoperative complications), may be assigned as principal diagnosis in the following instances:
 

sharon.cole

It should be coded but the encoder should not show it as an MCC once the death info is entered. I wouldn't think you should NOT code it just because the pt dies. Those statistics are still needed and monitored.


Cardiac Arrest 427.5 is not an MCC if the pt expires. Do not use it as a PDX if an underlying etiology is known and do not code it if the physician documents cardiac arrest to indicate the patient's death when the underlying cause or contributing cause of death is known.

See coding clinics 2nd Q 1988 pg 8 & 3rd Q 1995 pg 9.

Michele Goossen, RN, BSN, CHCQM
Clinical Documentation Specialist
Lakeland Regional Medical Center
863-687-1369

kmckaig

We code cadiac arrest if it occurs but my understanding is that it is only an MCC if resuscitation occurs.

mahmed1

I would use Respiratory failure as Pdx and cardiac arrest secondary if patient survive after resuscitation.

evanspx@sutterhealth.org

Linnea - since the (acute)? Respiratory failure was Present on Admission, it may be considered for use as the PDX - if it were not POA, it could not be used as the PDX.

Reference:

c. Acute Respiratory Failure

1) Acute respiratory failure as principal diagnosisICD-9-CM Official Guidelines for Coding and Reporting Effective October 1, 2011 Page 42 of 107



Acute respiratory failure, may be assigned as a principal diagnosis when it is the condition established after study to be chiefly responsible for occasioning the admission to the hospital, and the selection is supported by the Alphabetic Index and Tabular List. However, chapter-specific coding guidelines (such as obstetrics, poisoning, HIV, newborn) that provide sequencing direction take precedence.

2) Acute respiratory failure as secondary diagnosis
Respiratory failure may be listed as a secondary diagnosis if it occurs after admission, or if it is present on admission, but does not meet the definition of principal diagnosis.

Paul Evans, RHIA, CCS, CCS-P, CCDS

Supervisor, Clinical Documentation Integrity, Quality Department
California Pacific Medical Center
2351 Clay #243
San Francisco, CA 94115
Cell: 415.637.9002
Fax: 415.600.1325
Ofc: 415.600.3739
evanspx@sutterhealth.org

evanspx@sutterhealth.org

Should also reference this:


Sequencing of acute respiratory failure and another acute condition

When a patient is admitted with respiratory failure and another acute condition, (e.g., myocardial infarction, cerebrovascular accident, aspiration pneumonia), the principal diagnosis will not be the same in every situation. This applies whether the other acute condition is a respiratory or nonrespiratory condition. Selection of the principal diagnosis will be dependent on the circumstances of admission. If both the respiratory failure and the other acute condition are equally responsible for occasioning the admission to the hospital, and there are no chapter-specific sequencing rules, the guideline regarding two or more diagnoses that equally meet the definition for principal diagnosis (Section II, C.) may be applied in these situations.
If the documentation is not clear as to whether acute respiratory failure and another condition are equally responsible for occasioning the admission, query the provider for clarification.

Paul Evans, RHIA, CCS, CCS-P, CCDS

Supervisor, Clinical Documentation Integrity, Quality Department
California Pacific Medical Center
2351 Clay #243
San Francisco, CA 94115
Cell: 415.637.9002
Fax: 415.600.1325
Ofc: 415.600.3739
evanspx@sutterhealth.org

ddouthit

I agree with your coding manager. In this case per Coding clinic guidelines you would not pick up cardiac arrest. The only time cardiac arrest would be picked up is when an inpatient has cardiac arrest during stay and is discharged alive.
Is there a reason patient went into cardiac arrest? PE, Acute Respiratory Failure, MI?


Dorie

katysuegood@gmail.com

Hmmm.... My understanding of this CC was that cardiac arrest is not coded if it is the cause of death and the underlying cause of death is known. However, I thought that if the underlying cause is unknown you would still code the cardiac arrest. Since cardiac arrest occurs in every death, I thought this was to differentiate between a situation where there is another process being treated that ultimately leads to cardiac arrest vs sudden unexplained cardiac arrest.
I'll be interested in hearing other responses as I would never claim to be an expert on this.


Katy Good, RN, BSN, CCDS, CCS
Clinical Documentation Program Coordinator
AHIMA Approved ICD-10CM/PCS Trainer
Flagstaff Medical Center
Kathryn.Good@nahealth.com
Cell: 928.814.9404

jolene.file

I agree with your coding manager, Katy.  I would not code the cardiac arrest if it is the cause of death.  Cardiorespiratory arrest (427.5) is only calculated in the DRG as an  MCC when the pt. is discharged alive.   If you look in your ICD-9-CM code book under the code assignment there is a reference that the code 427.5 is an MCC only if pt. is discharged alive.   

Jolene File,RHIT,CCS,CPC-H,CCDS
Documentation Improvement Specialist-Coder
Hays Medical Center
jolene.file@haysmed.com

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vdavis2

I agree with your Coding Manager but can explain the rationale further based on the clinical rationale using Severity of Illness and Risk of Mortality. Maybe this will help out! You would not code the cardiac arrest since the patient expired. The pt’s colon cancer would be pdx and the pcx would be the bowel resection. The cardiac arrest can only be picked up as an mcc if the pt is discharged alive. Cardiac arrest is an integral part of death as someone stated in a previous response, so capturing the patients disposition code covers the death. Your APR-DRG will reflect that the pt died and the low SOI/ROI scores will reflect that the patient was not expected to die. This patient did have a higher risk of mortality with a bowel surgery given the age and reoccurrence of colon cancer. I would look to also make sure all of the comorbid conditions that go along with colon cancer were picked up. Malnutrition, clotting issues, ? radiation adhesions, chemo induced pancytopenia, etc. Were there areas of mets? Sounds like the pt may have had a post-op bowel leak, which can cause quick decompensation and rapid extremis. Ideally, you really need to have the physician clarify what the suspected cause of death/cardiac arrest so you are able to capture that information. If the underlying cause was something like a bowel perf or sepsis, those conditions will increase the SOI/ROM for this patient.

Good luck, let us know how this one turns out!!! ☺-V

Vicki Davis, RN CDS/CDI Manager
Alamance Regional Medical Center
North Carolina
Vdavis2@armc.com
336-586-3765