Dx needed

k.bloodsworth@smmctx.org · June 2015

I have a patient who was admitted for a hernia repair with mild obstruction. The surgery was delayed due to the patient taking Coumadin and the INR being within the therapeutic range of 2-3. The surgeon wanted the INR around 1 causing a delay in the surgery. Is there a diagnosis that would capture this?

kerryseekircher · June 2015

I don’t think so because the pt was actually in the appropriate range. It's not considered an abnormal lab value.
Are you looking for a dx to capture the extended length of stay?

Kerry Seekircher, RN, BSN, CCDS, CDIP
Documentation Specialist Supervisor
Northern Westchester Hospital
400 East Main Street
Mount Kisco, NY 10549
Email: kseekircher@nwhc.net
Phone: 914-666-1243
Fax: 914-666-1013

-----Original Message-----
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Tuesday, June 09, 2015 1:22 PM
To: Seekircher, Kerry
Subject: [cdi_talk] Dx needed

I have a patient who was admitted for a hernia repair with mild obstruction. The surgery was delayed due to the patient taking Coumadin and the INR being within the therapeutic range of 2-3. The surgeon wanted the INR around 1 causing a delay in the surgery. Is there a diagnosis that would capture this?
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k.bloodsworth@smmctx.org · June 2015

Yes we are looking for a diagnosis that would explain the extended LOS. The lab values were within the normal/expected range. The patient also received Vit K daily for 2 days. I don't know of any dx to capture this extended LOS.

Thanks,

Krystle Bloodsworth, LVN
Quality Improvement
CDI Specialist
St. Marks Medical Center
979-242-2327

-----Original Message-----
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Tuesday, June 09, 2015 12:35 PM
To: Krystle Bloodsworth
Subject: RE: [cdi_talk] Dx needed

I don’t think so because the pt was actually in the appropriate range. It's not considered an abnormal lab value.
Are you looking for a dx to capture the extended length of stay?

Kerry Seekircher, RN, BSN, CCDS, CDIP
Documentation Specialist Supervisor
Northern Westchester Hospital
400 East Main Street
Mount Kisco, NY 10549
Email: kseekircher@nwhc.net
Phone: 914-666-1243
Fax: 914-666-1013

-----Original Message-----
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Tuesday, June 09, 2015 1:22 PM
To: Seekircher, Kerry
Subject: [cdi_talk] Dx needed

I have a patient who was admitted for a hernia repair with mild obstruction. The surgery was delayed due to the patient taking Coumadin and the INR being within the therapeutic range of 2-3. The surgeon wanted the INR around 1 causing a delay in the surgery. Is there a diagnosis that would capture this?
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gwojo · June 2015

Wouldnt the obsyruction capture the extended LOS?
What was the LOS?

Sent via the Samsung Galaxy S™ III, an AT&T 4G LTE smartphone

-------- Original message --------From: CDI Talk Date:06/09/2015 12:46 PM (GMT-06:00) To: gwojo@wowway.com Subject: RE: [cdi_talk] Dx needed
Yes we are looking for a diagnosis that would explain the extended LOS. The lab values were within the normal/expected range. The patient also received Vit K daily for 2 days. I don't know of any dx to capture this extended LOS.

Thanks,

Krystle Bloodsworth, LVN
Quality Improvement
CDI Specialist
St. Marks Medical Center
979-242-2327

-----Original Message-----
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Tuesday, June 09, 2015 12:35 PM
To: Krystle Bloodsworth
Subject: RE: [cdi_talk] Dx needed

I don’t think so because the pt was actually in the appropriate range. It's not considered an abnormal lab value.
Are you looking for a dx to capture the extended length of stay?

Kerry Seekircher, RN, BSN, CCDS, CDIP
Documentation Specialist Supervisor
Northern Westchester Hospital
400 East Main Street
Mount Kisco, NY 10549
Email: kseekircher@nwhc.net
Phone: 914-666-1243
Fax: 914-666-1013

-----Original Message-----
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Tuesday, June 09, 2015 1:22 PM
To: Seekircher, Kerry
Subject: [cdi_talk] Dx needed

I have a patient who was admitted for a hernia repair with mild obstruction. The surgery was delayed due to the patient taking Coumadin and the INR being within the therapeutic range of 2-3. The surgeon wanted the INR around 1 causing a delay in the surgery. Is there a diagnosis that would capture this?
---
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Copyright 2013
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k.bloodsworth@smmctx.org · June 2015

The patient had a 5 day LOS and GMLOS is 2.1

Krystle Bloodsworth, LVN

Quality Improvement

CDI Specialist

St. Marks Medical Center

979-242-2327

From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Tuesday, June 09, 2015 12:51 PM
To: Krystle Bloodsworth
Subject: RE: [cdi_talk] Dx needed

Wouldnt the obsyruction capture the extended LOS?

What was the LOS?

Sent via the Samsung Galaxy S™ III, an AT&T 4G LTE smartphone

-------- Original message --------

From: CDI Talk

Date:06/09/2015 12:46 PM (GMT-06:00)

To: gwojo@wowway.com

Subject: RE: [cdi_talk] Dx needed

Yes we are looking for a diagnosis that would explain the extended LOS. The lab values were within the normal/expected range. The patient also received Vit K daily for 2 days. I don't know of any dx to capture this extended LOS.

Thanks,

Krystle Bloodsworth, LVN
Quality Improvement
CDI Specialist
St. Marks Medical Center
979-242-2327

-----Original Message-----
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Tuesday, June 09, 2015 12:35 PM
To: Krystle Bloodsworth
Subject: RE: [cdi_talk] Dx needed

I don’t think so because the pt was actually in the appropriate range. It's not considered an abnormal lab value.
Are you looking for a dx to capture the extended length of stay?

Kerry Seekircher, RN, BSN, CCDS, CDIP
Documentation Specialist Supervisor
Northern Westchester Hospital
400 East Main Street
Mount Kisco, NY 10549
Email: kseekircher@nwhc.net
Phone: 914-666-1243
Fax: 914-666-1013

-----Original Message-----
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Tuesday, June 09, 2015 1:22 PM
To: Seekircher, Kerry
Subject: [cdi_talk] Dx needed

I have a patient who was admitted for a hernia repair with mild obstruction. The surgery was delayed due to the patient taking Coumadin and the INR being within the therapeutic range of 2-3. The surgeon wanted the INR around 1 causing a delay in the surgery. Is there a diagnosis that would capture this?
---
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Copyright 2013
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angelisa.romanello · June 2015

I wonder if this might be a case management issue. When I was in CM we had a term for these days which extended the LOS and at this time, I cannot recall it.

Since the patient was actually admitted for the hernia repair with obstruction, I believe that would be your PDX.

Lisa

From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Tuesday, June 09, 2015 1:51 PM
To: Romanello Angelisa
Subject: [EXTERNAL] RE: [cdi_talk] Dx needed

Wouldnt the obsyruction capture the extended LOS?
What was the LOS?

Sent via the Samsung Galaxy S™ III, an AT&T 4G LTE smartphone

-------- Original message --------
From: CDI Talk
Date:06/09/2015 12:46 PM (GMT-06:00)
To: gwojo@wowway.com
Subject: RE: [cdi_talk] Dx needed

Yes we are looking for a diagnosis that would explain the extended LOS. The lab values were within the normal/expected range. The patient also received Vit K daily for 2 days. I don't know of any dx to capture this extended LOS.

Thanks,

Krystle Bloodsworth, LVN
Quality Improvement
CDI Specialist
St. Marks Medical Center
979-242-2327

-----Original Message-----
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Tuesday, June 09, 2015 12:35 PM
To: Krystle Bloodsworth
Subject: RE: [cdi_talk] Dx needed

I don’t think so because the pt was actually in the appropriate range. It's not considered an abnormal lab value.
Are you looking for a dx to capture the extended length of stay?

Kerry Seekircher, RN, BSN, CCDS, CDIP
Documentation Specialist Supervisor
Northern Westchester Hospital
400 East Main Street
Mount Kisco, NY 10549
Email: kseekircher@nwhc.net
Phone: 914-666-1243
Fax: 914-666-1013

-----Original Message-----
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Tuesday, June 09, 2015 1:22 PM
To: Seekircher, Kerry
Subject: [cdi_talk] Dx needed

I have a patient who was admitted for a hernia repair with mild obstruction. The surgery was delayed due to the patient taking Coumadin and the INR being within the therapeutic range of 2-3. The surgeon wanted the INR around 1 causing a delay in the surgery. Is there a diagnosis that would capture this?
---
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Copyright 2013
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Note:
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Any views expressed in this message are those of the individual sender, except where the message states otherwise and the sender is authorized to state them to be the views of any such entity.

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jolene.file · June 2015

Hi!

Have you coded the long-term usage of anticoagulant (v58.61)? I think this may help to explain why the pt had a longer stay.

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

IMPORTANT: This communication contains information from Hays Medical Center which may be confidential and privileged. If it appears that the communication was addressed or sent to you in error, you may not use or copy this communication or any information contained therein, and you may not disclose this communication or the information contained therein to anyone else. In such circumstances, please notify me immediately by reply email or by telephone. Thank you.

----- Original Message -----

From: "CDI Talk"
To: "jolene file"
Sent: Tuesday, June 9, 2015 12:57:06 PM
Subject: RE: RE: [cdi_talk] Dx needed

I wonder if this might be a case management issue. When I was in CM we had a term for these days which extended the LOS and at this time, I cannot recall it.

Since the patient was actually admitted for the hernia repair with obstruction, I believe that would be your PDX.

Lisa

From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Tuesday, June 09, 2015 1:51 PM
To: Romanello Angelisa
Subject: [EXTERNAL] RE: [cdi_talk] Dx needed

Wouldnt the obsyruction capture the extended LOS?

What was the LOS?

Sent via the Samsung Galaxy S™ III, an AT&T 4G LTE smartphone

-------- Original message --------

From: CDI Talk

Date:06/09/2015 12:46 PM (GMT-06:00)

To: gwojo@wowway.com

Subject: RE: [cdi_talk] Dx needed

Yes we are looking for a diagnosis that would explain the extended LOS. The lab values were within the normal/expected range. The patient also received Vit K daily for 2 days. I don't know of any dx to capture this extended LOS.

Thanks,

Krystle Bloodsworth, LVN
Quality Improvement
CDI Specialist
St. Marks Medical Center
979-242-2327

-----Original Message-----
From: CDI Talk [ mailto:cdi_talk@hcprotalk.com ]
Sent: Tuesday, June 09, 2015 12:35 PM
To: Krystle Bloodsworth
Subject: RE: [cdi_talk] Dx needed

I don’t think so because the pt was actually in the appropriate range. It's not considered an abnormal lab value.
Are you looking for a dx to capture the extended length of stay?

Kerry Seekircher, RN, BSN, CCDS, CDIP
Documentation Specialist Supervisor
Northern Westchester Hospital
400 East Main Street
Mount Kisco, NY 10549
Email: kseekircher@nwhc.net
Phone: 914-666-1243
Fax: 914-666-1013

-----Original Message-----
From: CDI Talk [ mailto:cdi_talk@hcprotalk.com ]
Sent: Tuesday, June 09, 2015 1:22 PM
To: Seekircher, Kerry
Subject: [cdi_talk] Dx needed

I have a patient who was admitted for a hernia repair with mild obstruction. The surgery was delayed due to the patient taking Coumadin and the INR being within the therapeutic range of 2-3. The surgeon wanted the INR around 1 causing a delay in the surgery. Is there a diagnosis that would capture this?
---
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Any views expressed in this message are those of the individual sender, except where the message states otherwise and the sender is authorized to state them to be the views of any such entity.

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gwojo · June 2015

Krystle, I cannot find a thing that would extend the LOS. Wish I vould help.

Sent via the Samsung Galaxy S™ III, an AT&T 4G LTE smartphone

-------- Original message --------From: CDI Talk Date:06/09/2015 12:54 PM (GMT-06:00) To: gwojo@wowway.com Subject: RE: [cdi_talk] Dx needed
The patient had a 5 day LOS and GMLOS is 2.1

Krystle Bloodsworth, LVN
Quality Improvement
CDI Specialist
St. Marks Medical Center
979-242-2327

From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Tuesday, June 09, 2015 12:51 PM
To: Krystle Bloodsworth
Subject: RE: [cdi_talk] Dx needed

Wouldnt the obsyruction capture the extended LOS?
What was the LOS?

Sent via the Samsung Galaxy S™ III, an AT&T 4G LTE smartphone

-------- Original message --------
From: CDI Talk
Date:06/09/2015 12:46 PM (GMT-06:00)
To: gwojo@wowway.com
Subject: RE: [cdi_talk] Dx needed

Yes we are looking for a diagnosis that would explain the extended LOS. The lab values were within the normal/expected range. The patient also received Vit K daily for 2 days. I don't know of any dx to capture this extended LOS.

Thanks,

Krystle Bloodsworth, LVN
Quality Improvement
CDI Specialist
St. Marks Medical Center
979-242-2327

-----Original Message-----
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Tuesday, June 09, 2015 12:35 PM
To: Krystle Bloodsworth
Subject: RE: [cdi_talk] Dx needed

I don’t think so because the pt was actually in the appropriate range. It's not considered an abnormal lab value.
Are you looking for a dx to capture the extended length of stay?

Kerry Seekircher, RN, BSN, CCDS, CDIP
Documentation Specialist Supervisor
Northern Westchester Hospital
400 East Main Street
Mount Kisco, NY 10549
Email: kseekircher@nwhc.net
Phone: 914-666-1243
Fax: 914-666-1013

-----Original Message-----
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Tuesday, June 09, 2015 1:22 PM
To: Seekircher, Kerry
Subject: [cdi_talk] Dx needed

I have a patient who was admitted for a hernia repair with mild obstruction. The surgery was delayed due to the patient taking Coumadin and the INR being within the therapeutic range of 2-3. The surgeon wanted the INR around 1 causing a delay in the surgery. Is there a diagnosis that would capture this?
---
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cynthia.hudson@christushealth.org · June 2015

Definitely think the hernia with obstruction would be the principal. I look hard at the chart to see if there were delays in care like slow return of bowel function postoperatively, uncontrolled pain, something out of the norm. Even if these issues are not reportable (codeable), they can be documented as delays in care which would show the reason for the extended length of stay. Our CM department reports these on each case.

Hope this helps.

Syndi Hudson, RN, CCDS,CCM
CHRISTUS Santa Rosa New Braunfels
CDI Specialist
cynthia.hudson@christushealth.org
830-643-6116 (Office)
830-643-5139 (Fax)
[Description: CCDS_pin_1inch]
“We are His hands”. Isaiah 64:8

From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Tuesday, June 09, 2015 12:57 PM
To: Hudson, Cynthia
Subject: RE: RE: [cdi_talk] Dx needed

I wonder if this might be a case management issue. When I was in CM we had a term for these days which extended the LOS and at this time, I cannot recall it.

Since the patient was actually admitted for the hernia repair with obstruction, I believe that would be your PDX.

Lisa

From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Tuesday, June 09, 2015 1:51 PM
To: Romanello Angelisa
Subject: [EXTERNAL] RE: [cdi_talk] Dx needed

Wouldnt the obsyruction capture the extended LOS?
What was the LOS?

Sent via the Samsung Galaxy S™ III, an AT&T 4G LTE smartphone

-------- Original message --------
From: CDI Talk
Date:06/09/2015 12:46 PM (GMT-06:00)
To: gwojo@wowway.com
Subject: RE: [cdi_talk] Dx needed

Yes we are looking for a diagnosis that would explain the extended LOS. The lab values were within the normal/expected range. The patient also received Vit K daily for 2 days. I don't know of any dx to capture this extended LOS.

Thanks,

Krystle Bloodsworth, LVN
Quality Improvement
CDI Specialist
St. Marks Medical Center
979-242-2327

-----Original Message-----
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Tuesday, June 09, 2015 12:35 PM
To: Krystle Bloodsworth
Subject: RE: [cdi_talk] Dx needed

I don’t think so because the pt was actually in the appropriate range. It's not considered an abnormal lab value.
Are you looking for a dx to capture the extended length of stay?

Kerry Seekircher, RN, BSN, CCDS, CDIP
Documentation Specialist Supervisor
Northern Westchester Hospital
400 East Main Street
Mount Kisco, NY 10549
Email: kseekircher@nwhc.net
Phone: 914-666-1243
Fax: 914-666-1013

-----Original Message-----
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Tuesday, June 09, 2015 1:22 PM
To: Seekircher, Kerry
Subject: [cdi_talk] Dx needed

I have a patient who was admitted for a hernia repair with mild obstruction. The surgery was delayed due to the patient taking Coumadin and the INR being within the therapeutic range of 2-3. The surgeon wanted the INR around 1 causing a delay in the surgery. Is there a diagnosis that would capture this?
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ssalinas · June 2015

You can use V58.83 and V58.61. This will not change the DRG but it does help explain the longer LOS. There are a couple of CC's on this. (Sorry I always cite CC but it is my Bible!)

The ones specifically related to this are:
CC 2002 3rd Qtr Pages 14-15 (Discontinuation of Coumadin therapy prior to colonoscopy)
CC 2002 3rd Qtr page 13 (Discontinuation of anticoagulant to perform procedure)

If you don't have access to Coding Clinic, let me know and I will provide the actual details.

Hope this helps.

Sharon Salinas, CCS
Health Information Management
Barlow Respiratory Hospital
2000 Stadium Way, Los Angeles CA 90026
Tel: 213-250-4200 ext 3336
FAX: 213-202-6490
ssalinas@barlow2000.org

-----Original Message-----
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Tuesday, June 09, 2015 10:22 AM
To: Salinas, Sharon
Subject: [cdi_talk] Dx needed

I have a patient who was admitted for a hernia repair with mild obstruction. The surgery was delayed due to the patient taking Coumadin and the INR being within the therapeutic range of 2-3. The surgeon wanted the INR around 1 causing a delay in the surgery. Is there a diagnosis that would capture this?
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Snook@fmchealth.org · June 2015

Lisa the term for extended but unnecessary LOS is called ‘avoidable days’. We categorize them and use the data to work with the physician or department that is lengthening the patient’s stay. I too used to work in CM.
Mary L. Snook RN-BC
Clinical Documentation Improvement Specialist
Fairfield Medical Center
740-689-4443

From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Tuesday, June 09, 2015 2:27 PM
To: Mary Snook
Subject: RE: RE: [cdi_talk] Dx needed

Definitely think the hernia with obstruction would be the principal. I look hard at the chart to see if there were delays in care like slow return of bowel function postoperatively, uncontrolled pain, something out of the norm. Even if these issues are not reportable (codeable), they can be documented as delays in care which would show the reason for the extended length of stay. Our CM department reports these on each case.

Hope this helps.

Syndi Hudson, RN, CCDS,CCM
CHRISTUS Santa Rosa New Braunfels
CDI Specialist
cynthia.hudson@christushealth.org
830-643-6116 (Office)
830-643-5139 (Fax)
[cid:image001.jpg@01D0A385.4A2F0E00]
“We are His hands”. Isaiah 64:8

From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Tuesday, June 09, 2015 12:57 PM
To: Hudson, Cynthia
Subject: RE: RE: [cdi_talk] Dx needed

I wonder if this might be a case management issue. When I was in CM we had a term for these days which extended the LOS and at this time, I cannot recall it.

Since the patient was actually admitted for the hernia repair with obstruction, I believe that would be your PDX.

Lisa

From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Tuesday, June 09, 2015 1:51 PM
To: Romanello Angelisa
Subject: [EXTERNAL] RE: [cdi_talk] Dx needed

Wouldnt the obsyruction capture the extended LOS?
What was the LOS?

Sent via the Samsung Galaxy S™ III, an AT&T 4G LTE smartphone

-------- Original message --------
From: CDI Talk
Date:06/09/2015 12:46 PM (GMT-06:00)
To: gwojo@wowway.com
Subject: RE: [cdi_talk] Dx needed

Yes we are looking for a diagnosis that would explain the extended LOS. The lab values were within the normal/expected range. The patient also received Vit K daily for 2 days. I don't know of any dx to capture this extended LOS.

Thanks,

Krystle Bloodsworth, LVN
Quality Improvement
CDI Specialist
St. Marks Medical Center
979-242-2327

-----Original Message-----
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Tuesday, June 09, 2015 12:35 PM
To: Krystle Bloodsworth
Subject: RE: [cdi_talk] Dx needed

I don’t think so because the pt was actually in the appropriate range. It's not considered an abnormal lab value.
Are you looking for a dx to capture the extended length of stay?

Kerry Seekircher, RN, BSN, CCDS, CDIP
Documentation Specialist Supervisor
Northern Westchester Hospital
400 East Main Street
Mount Kisco, NY 10549
Email: kseekircher@nwhc.net
Phone: 914-666-1243
Fax: 914-666-1013

-----Original Message-----
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Tuesday, June 09, 2015 1:22 PM
To: Seekircher, Kerry
Subject: [cdi_talk] Dx needed

I have a patient who was admitted for a hernia repair with mild obstruction. The surgery was delayed due to the patient taking Coumadin and the INR being within the therapeutic range of 2-3. The surgeon wanted the INR around 1 causing a delay in the surgery. Is there a diagnosis that would capture this?
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Copyright 2013
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Dx needed

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