Question regarding choking

renmeyer@sbcglobal.netrenmeyer@sbcglobal.net
in CDI Talk Archive
Hi everyone.

I need some help figuring this one out please.

Patient was eating breakfast and had some choking spells and stopped responding. Large amount of emesis suctioned from mouth by paramedic. Desaturated on non-rebreather mask and was intubated in ER and admitted. MD documented Resp failure, aspiration pneumonia, Non-Stemi, COPD exacerbation and acute renal failure all as POA. MD consistently documents 'Acute resp failure due to COPD exacerbation and aspiration pna'. What would the DRG be in a case like this? I thought it would be Aspiration PNA, DRG 177, but coder states it has to be DRG 154 (T17220A - Food in pharynx causing asphyxiation)because "the aspiration of the food, which blocked his airway, caused all the other acute conditions". It never crossed my mind to use DRG 154 and I'm not sure that I agree. Any thoughts on this would be very helpful.

Thanks!

Renee Meyer, RN, CCDS

Comments

  • katysuegood@gmail.comkatysuegood@gmail.com
    edited March 2016
    I would be ok with coding the resp failure or pna pneumonia as PDx if these were the focus of care (you have some other acute conditions listed but I am working on the assumption that these were not the focus based on your question). I would not sequence the choking first. We don’t have to fallow the train of 'underlying cause' back forever (just symptoms or when guidelines/tabular tell us to) but I see people get hung up on that stuff sometimes. The choking was not the focus of care during the inpatient admission.

    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


  • evanspx@sutterhealth.orgevanspx@sutterhealth.org
    edited March 2016
    Clearly, this is reported as aspiration pneumonia as the principal Dx. I am not sure how anyone would advocate otherwise?





    [cid:image001.png@01D14DDE.A1268630]



    [cid:image002.png@01D14DDE.A1268630]



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



    Manager, Regional Clinical Documentation & Coding Integrity

    Sutter West Bay

    633 Folsom St., 7th Floor, Office 7-044

    San Francisco, CA 94107

    Cell: 415.412.9421



    evanspx@sutterhealth.org









  • ssalinasssalinas
    edited March 2016
    I think we need to start at the very beginning of the inpatient coding sequence for this one.

    Principal diagnosis is the condition that caused admission to inpatient care. The patient came into the ER for choking episode. However at the point of admission to inpatient status, the choking episode had been resolved. If it had just been choking/emesis with no further harm, the patient would have been sent home.

    The condition which necessitated admission to inpatient was one of the diagnoses listed below, not the choking episode. I can't say for sure which I would choose as principal diagnosis without more detail in length of intubation and ventilation, etc. and but I would probably go with the aspiration pneumonia as well.

    Just my thoughts on how to perhaps approach the coder regarding this.

    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


  • vanessa.falkoffvanessa.falkoff
    edited March 2016
    I have had a similar case and I agree with Sharon.

    Vanessa Falkoff RN
    Clinical Documentation Improvement Coordinator
    University Medical Center of Southern Nevada
    1800 W Charleston Blvd
    Las Vegas, NV
    vanessa.falkoff@umcsn.com
    office 702-383-7322

    Compassion * Accountability * Respect * Integrity



  • renmeyer@sbcglobal.netrenmeyer@sbcglobal.net
    What a great place to come to, to get input and feedback. Thanks guys!
    I will send it for a secondary review.

    Renee, RN, CCDS
Sign In or Register to comment.