bronch

katysuegood@gmail.comkatysuegood@gmail.com
in CDI Talk Archive
I feel like this is a basic question but I want to make sure I am pointing coding in the right direction.

Patient presents with end stage COPD with resp failure. Later develops hemoptysis. We do a bronch. Documentation states:



Bronchoscope was passed through an 8.0 endotracheal tube. The tube was confirmed

to be 3 cm above the carina. There was initially some scant hemoptysis in the central airways.

This was suctioned to clear. It appeared that there was blood pooling at a slow rate in the

left lower lobe below the superior segment. This again was suctioned to clear and the patient

was treated with serial iced saline. No specimens were obtained during this procedure.

Procedure was well tolerated without complications.

What is the root operation for the bronch in this scenario?

Thanks!


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

Comments

  • kwilliams@halifaxrmc.orgkwilliams@halifaxrmc.org
    edited March 2016
    Would it be inspection?

    Kim Williams, RN
    Clinical Documentation Specialist
    Halifax Regional
    Revenue Management Department
    kwilliams@halifaxrmc.org
    (252) 535-8154
    (252) 535-8937 fax
  • katysuegood@gmail.comkatysuegood@gmail.com
    edited March 2016
    I see this as inspection. The coder is saying that she is trying to code the aspiration of mucous. She is ending up with extirpation as the root operation (0BCJ8ZZ) throwing us in a surgical DRG which I do not think is appropriate for this patient.

    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

  • kwilliams@halifaxrmc.orgkwilliams@halifaxrmc.org
    edited March 2016
    Extripation is taking or cutting out solid matter from a body part. Ex. trombectomy, choledocholithotomy, excision foreign body.


    Kim Williams, RN
    Clinical Documentation Specialist
    Halifax Regional
    Revenue Management Department
    kwilliams@halifaxrmc.org
    (252) 535-8154
    (252) 535-8937 fax

  • katysuegood@gmail.comkatysuegood@gmail.com
    edited March 2016
    Exactly. I provided the definition. I think she is getting hung up on where the coding tree is leading her but she knows she's ending up in the wrong place. I was trying to find some sort of resource to make her feel more confident but haven't found one yet.

    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

  • kwilliams@halifaxrmc.orgkwilliams@halifaxrmc.org
    edited March 2016
    I got mine from HCPro CDI 10 Boot Camp Module Three PCS-16.


    Kim Williams, RN
    Clinical Documentation Specialist
    Halifax Regional
    Revenue Management Department
    kwilliams@halifaxrmc.org
    (252) 535-8154
    (252) 535-8937 fax
  • katysuegood@gmail.comkatysuegood@gmail.com
    edited March 2016
    Thanks Kim,
    I have the reference for the definitions. I was looking for a reference specific to a similar bronch procedure but I haven't some across one (Yet).


    Thanks so much for your help :).

    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
  • kwilliams@halifaxrmc.orgkwilliams@halifaxrmc.org
    edited March 2016
    Sure. You have helped us all many, many times!

    Kim Williams, RN
    Clinical Documentation Specialist
    Halifax Regional
    Revenue Management Department
    kwilliams@halifaxrmc.org
    (252) 535-8154
    (252) 535-8937 fax

  • evanspx@sutterhealth.orgevanspx@sutterhealth.org
    edited March 2016
    Perhaps focus on the fact that aspiration of mucus or blood does not constitute the 'taking' out of SOLID matter? That misclassification of the root procedure is the root problem for the coder - or so it sounds?



    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

  • lconaway@altoonaregional.orglconaway@altoonaregional.org
    edited March 2016
    What about DRAINAGE? It is difficult to understand the reasoning but we know now that Bronchoscopy with brushing/ washing of the lung counts as a valid OR as does insertion of arterial lines, paracentesis, banding of esophageal varices and non-excisional debridement's. Who knew. Given the information you provided, it seems like suctioning the blood from the pts airways was the focus. I do get a valid OR procedure. I get 0B9B8ZZ.


    LeeAnn Conaway, RN III, CCRN, CCDS
    CDS Coordinator
    UPMC Altoona
    Quality Management
    814-889-3313 office
    814-502-6772 cell
  • ssalinasssalinas
    edited March 2016
    More questions than answers from me -

    * The root operation specifies the objective of the procedure.

    o Was control of bleeding the objective?

    o Would irrigation be the root operation?

    * Should the aspiration of mucous be coded separately?

    o Were multiple root operations performed with different objectives?

    o Or was aspiration of the mucous just part of the procedure?


    PCS guidelines state that FOB performed for irrigation of bronchus , only the irrigation is performed.

    As I said, I'm not sure if the mucous plug aspiration should be coded in addition or not.

    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
  • katysuegood@gmail.comkatysuegood@gmail.com
    edited March 2016
    Hi Sharon,
    Unfortunately, we don't have any more documentation regarding the procedure than I provided. However, the progress notes basically say that the patient had sudden frank hemoptysis. He has had this 2 years prior as well, had a bronch at that time and it was coming from the LLL. They did nothing to control the bleeding that I can see aside from using iced saline. After the bronch, they said if it continued they would consider embolization but they did not end up doing this as bleeding stopped on its own. To me, the aspiration of mucous seems incidental. Thinking about my resp ICU experience, basically all bronchs included suctioning but I am not sure.

    Frustrating how confusing such a simple procedure can be....

    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
  • annnd2009@gmail.comannnd2009@gmail.com
    edited March 2016
    When I put through 3m encoder and get 0bc88zz- it does not drive the DRG? I entered PNA as Pdx and that is the DRG 195...

    Ann

    Sent from my iPhone

  • lconaway@altoonaregional.orglconaway@altoonaregional.org
    edited March 2016
    Ann,

    That code uses Extirpation as the root which would be incorrect as the objective of the procedure was not to take or cut out solid matter.
    I am sure I am not alone when I say I despise these new root words!

    LeeAnn

  • evanspx@sutterhealth.orgevanspx@sutterhealth.org
    edited March 2016
    There is a lot of confusion on these messages regarding procedures that drive to a Surgical MS-DRG….a bronch w/ ‘only’ washing will not, if coded properly, generate a surgical DRG. A bronch w/ a true ‘transbronchial Bx of lung tissue’ will drive to a surgical case.


    Non-excisional debridement will not drive to surgical DRG, but true surgical debridement is a valid O.R. procedure.

    I believe the nuances and multitude of choices in PCS make the coding of PCS very detailed.


    Sorry can’t be of more help, but please check each category of each character assigned for some of these mentioned procedures.

    PE

    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

  • annnd2009@gmail.comannnd2009@gmail.com
    edited March 2016
    I didn't "choose the root word" I chose removal of foreign body in parentheses ( aspiration of mucus plug).
    I also ran it through with bronchial alveolar lavage and while the root is drainage-- NEITHER effected DRG... I thought that was the main concern?

    I just like to follow others discoveries- don't begin to claim expertise!

    Thanks
    Ann

    Sent from my iPhone
  • evanspx@sutterhealth.orgevanspx@sutterhealth.org
    edited March 2016
    No worries…PCS can be difficult. I wish I had time to contribute more today, but I have my quota to meet. I only wish to say we should all take a 2nd look at the way some of these are being coded.

    Removal of mucus is not coded to removal of foreign body as the mucus is not foreign to this anatomical location. In my practice, Bronchoscopy ‘almost never’ impacts the DRG unless actual lung tissue is biopsied – washings and so forth do not impact DRG.



    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

  • katysuegood@gmail.comkatysuegood@gmail.com
    edited March 2016
    Thanks Dr. Gold. This is what I thought as well. Aspiration of mucous always happens. What about the iced saline? Should this be interpreted as an irrigation to stop bleeding?

    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


  • lconaway@altoonaregional.orglconaway@altoonaregional.org
    edited March 2016
    Paul… when you get a minute, check ICD-10 0B968ZZ. This code looks like it counts.

    Katy… I wonder if it makes a difference that they were suctioning blood, not just mucus since the hemoptysis seems like what led to doing the bronch in the first place?

    LeeAnn
  • evanspx@sutterhealth.orgevanspx@sutterhealth.org
    edited March 2016
    Excerpt: PCS Guidelines


    (May be helpful, depending upon circumstances of each case)



    Inspection procedures

    B3.11a

    Inspection of a body part(s) performed in order to achieve the objective of a procedure is not coded separately.
    Example: Fiberoptic bronchoscopy performed for irrigation of bronchus, only the irrigation procedure is coded.


    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

    [cid:image001.jpg@01D14DFD.69496F60]

    From: Evans, Paul
    Sent: Wednesday, January 13, 2016 11:57 AM
    To: 'cdi_talk@hcprotalk.com'
    Subject: RE: [cdi_talk] bronch

    No worries…PCS can be difficult. I wish I had time to contribute more today, but I have my quota to meet. I only wish to say we should all take a 2nd look at the way some of these are being coded.

    Removal of mucus is not coded to removal of foreign body as the mucus is not foreign to this anatomical location. In my practice, Bronchoscopy ‘almost never’ impacts the DRG unless actual lung tissue is biopsied – washings and so forth do not impact DRG.



    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
    That is what I was thinking when I suggested irrigation regarding the iced saline.

    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

  • ssalinasssalinas
    edited March 2016
    That is the guideline I referenced earlier so agree with you Paul. I think the irrigation with the iced saline was irrigation.

    (My brain is spinning.)

    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

  • Unknown
    edited March 2016
    I think that would be reasonable. I've done irrigations of many different types of tubes to try to stop bleeding, so I think your choice is quite reasonable.

    Robert S. Gold, MD
    CEO, DCBA, Inc
    4611 Brierwood Place
    Atlanta, GA 30360
    (770) 216-9691 (Office)
    (404) 580-0204 (Cell)
  • katysuegood@gmail.comkatysuegood@gmail.com
    edited March 2016
    Thanks so much for everyone's input!!

    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
    I BRIEFLY played w/ my coding software –


    Drainage of LUNG can result in a procedure that impacts DRG assignment.



    [cid:image001.png@01D14E1F.DE7690C0]



    Drainage of BRONCHUS (BAL) did not impact DRG when I set up a dummy case.



    Drainage, LL Bronchus, Endoscopic, No Device, Diagnostic

    (BAL) – Dummy case below generates a Medical DRG, not Surgical

    [cid:image002.png@01D14E1C.61645070]




    [cid:image003.png@01D14E1C.61645070]

    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

  • kerryseekircherkerryseekircher
    edited March 2016
    I have a case that was coded to MS-DRG 163. At first, I thought it was coded incorrectly because the pt had a bronch w/o lung biopsy.
    However, when I code the removal of a mucous plug from the right upper lobe, I’m getting code 0BCC8ZZ with the root operation of extirpation (see pathway below).
    [cid:image001.png@01D14EEC.39531690]

    In contrast, when I code the same procedure but to a different site (bronchus), it remains in the medical DRG.
    I coded the same procedure in 9 and the codes look like this-there is no option to further specify location, so I’m wondering if this is a DRG shift based on location of the removal of the plug or a flaw of the system?

    [cid:image002.png@01D14EEE.A570EF80]
    I’m concerned as well as this is a change and curious to see how others are handling similar claims.
    Katy-what did you decide on in your case?


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

  • evanspx@sutterhealth.orgevanspx@sutterhealth.org
    edited March 2016
    I recreated same scenario and derived same MS-DRGs. Not sure if this is a flaw in the system or a DRG shift, either? Puzzling to me as it is not ‘logical’ that removing mucus from the lung should drive to a surgical DRG?

    Someone else also stated that insertion of an A-line can now drive to a surgical MS-DRG, and I have experienced this, too. Not sure if this is a problem w/ code site or oversight in DRG pathways? Seems implausible that insertion of A-line in Upper Artery for monitoring should impact DRG – think of all the septic patients this may impact?

    Color me confused?



    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
  • m.leblancm.leblanc
    edited March 2016
    I am with Paul. Is it possible that a query is warranted to make sure it was the lobe of the lung and not a bronchus that was plugged blocking oxygen from entering the lung. I would query the provider before going to a Major Chest Procedure DRG.

    Thanks and good luck,

    Mark

  • Unknown
    edited March 2016
    For interest sake, drainage of lung means that there is a cyst or abscess of the lung which might be approached through open surgery or thoracoscope or percutaneous or through a bronchoscope for drainage of this collection. It has nothing to do with stuff that blocks up the bronchial tree at all.

    Robert S. Gold, MD
    CEO, DCBA, Inc
    4611 Brierwood Place
    Atlanta, GA 30360
    (770) 216-9691 (Office)
    (404) 580-0204 (Cell)
  • evanspx@sutterhealth.orgevanspx@sutterhealth.org
    edited March 2016
    Dr. Gold

    100% agree….from the limited time I have had to code some of the questioned procedures, I ‘believe’ that, even when we all agree the correct procedure PCS code is applied, we are now seeing certain procedures that are now impacting DRG assignment, but were not impacting DRG assignment until 1 Oct of this year….(such as insertion of A –lines and certain bronchial procedures, just to name a few identified issues w/ PCS using I-10. I wonder if this is the intent of those that built logic for our current grouper?)

    Thanks, PE



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

    Manager, Regional Clinical Documentation
    Sutter West Bay
    633 Folsom St., 7th Floor, Office 7-044
    San Francisco, CA 94107
    Cell: 415.412.9421



    evanspx@sutterhealth.org

  • m.leblancm.leblanc
    edited March 2016
    Thanks Dr. Gold,

    You define drainage of lung but the code that is coming up is removal (extirpation) of matter from right upper lobe of lung and not drainage?

    Thanks,

    Mark

  • Unknown
    edited March 2016
    OBCC is removal of matter (whatever tissue or pus or …) from the lung, not from the right upper lobe mainstem bronchus. That’s what’s done for remoqal of mucous plugs. It’s not lung that has stuff removed – it’s bronchus. The docs frequently leave that word out., You can’t remove stuff from lung without perforating (intentionally) the wall of the bronchus. Inspissated mucous is in the bronchus or trachea – not the lung. And suctioning of liquid out of wherever is drainage. If it’s solid matter, that would be extirpation.

    Robert S. Gold, MD
    CEO, DCBA, Inc
    4611 Brierwood Place
    Atlanta, GA 30360
    (770) 216-9691 (Office)
    (404) 580-0204 (Cell)

  • katysuegood@gmail.comkatysuegood@gmail.com
    edited March 2016
    This makes sense. I believe if it is coded to the bronchus, it isn’t a major procedure. Right?

    But it does go to extirpation, as far as I can see when we code a removal of mucous plug.
    [cid:image009.png@01D158F8.2A7FB040]
    [cid:image010.png@01D158F8.2A7FB040]

    Based on those options, I think the natural selection for removal of a mucous plus is 3 (on the second screen), even issue you select bronchus, you end up with Extirpation 0BC88ZZ.

    Do I have this right?

    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
    This is an example of a procedure coded in PCS that is now apparently generating a Surgical MS-DRG – last year, the same code in I-9 did not impact DRG assignment.

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

    Manager, Regional Clinical Documentation
    Sutter West Bay
    633 Folsom St., 7th Floor, Office 7-044
    San Francisco, CA 94107
    Cell: 415.412.9421



    evanspx@sutterhealth.org

  • Unknown
    edited March 2016
    I just entered these codes into my latest version of ICD-10 grouper and I come up with no OR procedure with 0BC88ZZ. I agree with Katy.

    Robert S. Gold, MD
    CEO, DCBA, Inc
    4611 Brierwood Place
    Atlanta, GA 30360
    (770) 216-9691 (Office)
    (404) 580-0204 (Cell)

  • evanspx@sutterhealth.orgevanspx@sutterhealth.org
    edited March 2016
    Sorry: I am getting lost in all of these messages about different conditions and PCS procedures. I also entered 0BC88ZZ into a grouper for a case with a respiratory principal diagnosis and the procedure code did not impact the DRG Assignment.
    Paul Evans, RHIA, CCS, CCS-P, CCDS

    Manager, Regional Clinical Documentation
    Sutter West Bay
    633 Folsom St., 7th Floor, Office 7-044
    San Francisco, CA 94107
    Cell: 415.412.9421



    evanspx@sutterhealth.org

  • kerryseekircherkerryseekircher
    edited March 2016
    I had queried the MD and he felt strongly that he removed mucous from the rul and the bronchus.
    Below is the documentation that I have to work with.
    Closing thoughts?


    Procedure: Bronchoscopy
    Indications:
    Atelectasis of the right middle lobe, Atelectasis of
    the right lower lobe, Lung collapse
    Impression: -
    A mucous plug was found in the bronchus intermedius,
    in the right upper lobe, in the medial segment of the
    right middle lobe (B5) and in the right lower lobe.
    - No specimens collected.
    Findings:
    Left Lung Abnormalities:
    Right Lung Abnormalities: Mucous, plugging the airway, was found in the
    bronchus intermedius, in the right upper lobe, in the medial segment of
    the right middle lobe (B5) and in the right lower lobe. The mucous was
    copious, tenacious, white, thick and odorless. [Underlying mucosa].
    Complications: No immediate complications
    Recommendation: - Chest X-ray post-procedure.
    - Bronchial hygiene.
    CPT(R) Code(s): --- Professional ---
    31622, Bronchoscopy, rigid or flexible, including
    fluoroscopic guidance, when performed; diagnostic, with
    cell washing, when performed (separate procedure)
    ICD Code(s): --- Professional ---
    T17.990A, Other foreign object in respiratory tract,
    part unspecified in causing asphyxiation, initial
    encounter
    J98.11, Atelectasis
    J98.19, Other pulmonary collapse

    Brief Procedure Note

    Pt is s/p bronchoscopy for RML/RLL lung collapse due to mucous inspissation. Pt had very tenacious, white, thick mucous obstructing RUL, Bronchus Intermedius, LUL, L lingula and LLL. I suctioned out all secretions- using total of 155cc NS in process. All airways open and patent. Pt tolerated procedure well. Secretions sent for gm stain, cx, sensitivity and pathology.
    Will order CXR to evaluate RLL.

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

  • evanspx@sutterhealth.orgevanspx@sutterhealth.org
    edited March 2016
    The procedures are stated as occurring ‘within’ the lumen of various locations of the bronchus –I’d code these to bronchial procedures (performed on bronchus) given there was not a transbronchial approach and actual lung was not entered. Rather, the report describes various portions of the bronchus corresponding to lobes of the lung. Coding of ‘washing’ – or “biopsy” of bronchus is distinguished from that involving transbroncoscopic procedures crossing FROM the bronchus to actual lung parenchyma.

    It can sometimes be difficult to decide how to code endobronchial procedures, but I always ask myself if the procedure is confined within the lumen of the bronchus of was the bronchus crossed to lung tissue…hope this helps for any future cases.



    PE

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

    Manager, Regional Clinical Documentation
    Sutter West Bay
    633 Folsom St., 7th Floor, Office 7-044
    San Francisco, CA 94107
    Cell: 415.412.9421



    evanspx@sutterhealth.org

  • m.leblancm.leblanc
    edited March 2016
    It appears that we were all on the same page in giving input around the bronchoscopy being bronchus and not lung which drives to an OR procedure that is not a Surgical DRG and leaves it in the Medical DRG.

    These exchanges are so educational and help to shed clarity on the fact that we need to look beyond the words and utilize our A&P as well.

    Thanks everyone!

    Mark
  • kerryseekircherkerryseekircher
    edited March 2016
    Thank you everyone.
    This case was a struggle for me and I appreciate all of your valuable feedback.
    Kerry


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

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