DNR Status

dvitalone1dvitalone1
in CDI Talk Archive
It has been decided at our facility's Inpt Coding meeting today that V49.86 DNR status no longer needs to be coded. The CDI Department does not agree with this. What are any our your thoughts? Thank you in advance for your response.

Dawn

Comments

  • cmclose@saintfrancis.comcmclose@saintfrancis.com
    edited May 2016
    I disagree~ I think DNR status SHOULD be coded!

    Claudine Hutchinson RN
    Clinical Documentation Improvement Specialist
    Children's Hospital at Saint Francis
    Email: chutchinson@saintfrancis.com
    Office: (918) 502-6603
    Pager: 98-1001
  • sharon.colesharon.cole
    edited May 2016
    Definitely should be coded. What are your facility's reasons for choosing not to code?

    Sharon Cole, RN, CCDS
    Case Management
    254.751.4256
    srcole@phn-waco.org
  • ddouthitddouthit
    I am almost 100% sure that DNR status effects report cards and ROM AND SOI.
  • dvitalone1dvitalone1
    edited May 2016
    Funny you should ask. I was told that because the coders abstracts (which is not sent to Medicare) the DNR status that it is just easier if they did not have to code it also.

    Dawn
  • mdomineseymdominesey
    edited May 2016
    I agree with it affecting report cards; not so sure about SOI/ROM. Maybe it is used to explain someone dying with a low SOI/ROM? i.e. interventions not done d/t DNR status for someone with a progressive illness? Hospice needs to be in the top 8 (or is it 16) codes for reporting purposes, but not sure about DNR.

    Mark

    Mark N. Dominesey, RN, BSN, MBA, CCDS
    Sr. Clinical Documentation Improvement Specialist
    Sibley Memorial Hospital

    http://www.sibley.org
  • Unknown
    edited May 2016
    My understanding is that it very much affects mortality audits. So if
    no DNR is coded in a patient with lung cancer and the patient goes in to
    resp.arrest and we ask the doc to dictate resp.arrest or failure vs.
    resp.insuffucuency, won't an auditor want to know why no treatment was
    provided for resp.failure? It seems like quality of care could be
    called in to question.

    That doesn't sound like a good idea to me.

    Donna Kent, RN, BSN, CCDS
    Manager, Clinical Documentation Integrity Program
    Clinical Quality and Accreditation
    Torrance Memorial Medical Center
    ph.:310 784-6884 fax:310 784-6899
    donna.kent@tmmc.com
  • katysuegood@gmail.comkatysuegood@gmail.com
    I am in charge of our death registry. I review all death charts and i have a special report that inputs demographic data and data abstracted from coding and then I input data, such as the impact of my review of the death chart (prior to coding being finalized), days in ICU, days on CC, etc.
    We are specifically asked to track DNR status (whether the patient was DNR on admission and when they became DNR, if ever). Therefore, I certainly think that code-status should be coded. I actualy check that it has been coded prior to the chart beign dropped (the way our system works, the coders to a "draft" coding and then me and our coding manager review it and make any necessary changes/query prior to finalization).

    Katy
  • Unknown
    edited May 2016
    That sounds similar to what happens here. One of OSHPD's questions to
    be answered is whether there was a DNR in the first 24 hours.

    Donna Kent, RN, BSN, CCDS
    Manager, Clinical Documentation Integrity Program
    Clinical Quality and Accreditation
    Torrance Memorial Medical Center
    ph.:310 784-6884 fax:310 784-6899
    donna.kent@tmmc.com
  • ssalinasssalinas
    edited May 2016
    As said below, OSHPD in California requires that DNR orders within 24
    hours of admit be reported to them. Using the DNR ICD-9-CM code allows
    one to report the status regardless of when it actually occurs.
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