cardiac arrest on an inpatient death

Unknown

We are having a conflict on whether to code cardiac arrest as a secondary diagnosis on an inpatient death when the cause of death is known. For example, a patient admitted with a massive subarachnoid hemorrhage who became bradycardic and went into a cardiac arrest 2 days after admission and died. Coding Clinic advice from second quarter 1988 states do not assign code 427.5 when the underlying cause or contributing cause of death is known since the UHDDS has a separate item for reporting deaths during an inpatient stay. On the other hand, in the article found on ACDIS "Improve predicted mortality rates through documentation" we are instructed to document the dying process, such as cardiac arrest. Should we capture this diagnosis?

Debbie Loeffler, RHIA

fosterma

My opinion is that if the Cardiac arrest was treated with meds, CPR, Shocks, etc and lead to positive resuscitation, it should be coded. If the patient was not resuscitated than it is probably not appropriate to code. The way to capture the ROM would have been if the team had realized the patient would die from the SAH, they could have ordered or designated the patient as palliative or comfort care only. This way, the death has been documented as expected. Hope this helps.
Roberta

jrstee2

In my opinion, it is not enough to document SAH and palliative care. SAH carries a risk of mortality (ROM) of 2 or moderate. Palliative care does not increase your ROM it only implies that you are no longer treating the patients terminal condition. So yes, I agree with article posted on ACDIS, it is important to document all diagnoses that contributed to the patient's death if treated, evaluated, etc. In the case of SAH what caused the patient to die? By documenting compression of brain, cerebral edema, or coma, which are all complicating factors that lead to death in SAH, you have now increased the patient's ROM to be extreme.

Julian

Unknown

Thank you. We have formulated a policy to code cardiac arrest as a
secondary diagnosis only when the patient is resuscitated or an attempt was made
to resuscitate the patient.