PDX for admission - usa vs cardiomyopathy

We had a case we tried to learn from but it's hard when people feel they are on different camps- people don't share what they know and people aren't interested in seeing more than their view point.

There was a pt who came in with CP (not your typical semi-bogus CP). , ended up in the unit on ntg gtt for two days. He had an extensive history with multiple interventions,which had pretty much been exhausted (including a cabg redo). MD documented cmo with usa and usa with CMO. Is there a way to ask and have ischemic cardiomyopathy coded as primary diagnosis? Even though it may not be the norm, considering his cardiac status is what bought the bed and caused him to have the ntg gtt and warrented more intervention if the risks were acceptable (he was also esrd, ended up with pneumonia and sepsis and chf).

Though he ended up with pna , it wasn't referenced for 3 days and it became pdx, which seemed to evolve to me. lungs were clear on admission. It seemed to be an evolution of his debilitated state.

There had been discussions but in the end the coder did not feel she could code CMO, "we never code that as primary". I attempted to construct a query that would satisfy the requirements that she felt was accurate that could lead to ischemic cardiomyopathy being coded as primary. In the end again was told it couldn't be coded.
the answer to the query was (as advised to be written as this) : usa d/t cardiomyopathy...would it have worked if I had said cp due to cardiomyopathy or is it never possible to code ischemic cardiomyopathy. { This just seemed like more than a standard USA that a med change would solve- I think they ended up going to hospice house for end stage cardiomyopathy}.

Thanks appreciate any input.

Comments

  • Cardiomyopathy is a chronic condition and therefore not the best choice for justifying an inpatient admission. I would never use it unless I absolutely positively had nothing else, but then I'd be looking to see if the pt met IP criteria. If the patient is symptomatic, I'd be looking at CHF. But you said the patient had clear lungs, etc., on admission. What other clinical indicators did he have on admission that will help you determine the pdx? NTG isn't going to fix cardiomyopathy. Does the pt have documented CAD? Then the USA would go under the CAD.

    Renee


    Linda Renee Brown, RN, CCRN, CCDS
    Certified Clinical Documentation Specialist
    Banner Good Samaritan Medical Center
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