sequencing

katysuegood@gmail.comkatysuegood@gmail.com
in CDI Talk Archive
Hi all,
I have a VERY complex patient with a very long LOS. Pt had laryngeal ca but presented with acute kidney failure, GI bleed, resp failure, etc. GI bleed resolved within first week but pt continues to be tenuous. CHF, ATN, etc. Initially thrombocytopenia was thought to be due to Plavix. Day 12 he has recurrent bleed, duodenal, which is cauterized. Thrombocytopenia worsens as does renal failure. HD is intiated and workup continues. He continues to re-bleed. Hemostatic clips placed in repeat EGD. Eventually he is diagnosed with Atypcial hemolytic-uremic syndrome.

Currently the duodenal clips are the DRG driving procedure but the coder had the hemolytic-uremic syndrome as Pdx which puts us in DRG 981. Is this sequencing correct or should the duodenal ulcers (bleeding) be Pdx putting us in DRG 326 (stomach, esoph, duodenal procedures)

Katy Good, RN, BSN, CCDS, CCS
Clinical Documentation Program Coordinator
Flagstaff Medical Center
Kathryn.Good@nahealth.com
Cell: 928.814.9404

Comments

  • gwojogwojo
    Yes, the GI bleed is acute, the syndrome chronic. The GI bleed should be considered for pdx.
    Sent from my BlackBerry 10 smartphone. From: CDI TalkSent: Wednesday, February 10, 2016 7:04 PMTo: gwojo@wowway.comReply To: cdi_talk@hcprotalk.comSubject: [cdi_talk] sequencing






    Hi all,

    I have a VERY complex patient with a very long LOS. Pt had laryngeal ca but presented with acute kidney failure, GI bleed, resp failure, etc.  GI bleed resolved within first week but pt continues to be tenuous. CHF, ATN, etc. Initially
    thrombocytopenia was thought to be due to Plavix. Day 12 he has recurrent bleed, duodenal, which is cauterized. Thrombocytopenia worsens as does renal failure. HD is intiated and workup continues. He continues to re-bleed. Hemostatic clips  placed in repeat
    EGD. Eventually he is diagnosed with Atypcial hemolytic-uremic syndrome.

     

    Currently the duodenal clips are the DRG driving procedure but the coder had the hemolytic-uremic syndrome as Pdx which puts us in DRG 981. Is this sequencing correct or should the duodenal ulcers (bleeding) be Pdx putting us in DRG 326
    (stomach, esoph, duodenal procedures)

     

    Katy Good, RN, BSN, CCDS, CCS

    Clinical Documentation Program Coordinator

    Flagstaff Medical Center

    Kathryn.Good@nahealth.com

    Cell: 928.814.9404

     


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  • katysuegood@gmail.comkatysuegood@gmail.com
    edited March 2016
    Thanks so much, this is what I was thinking too ☺

    Katy Good, RN, BSN, CCDS, CCS
    Clinical Documentation Program Coordinator
    Flagstaff Medical Center
    Kathryn.Good@nahealth.com
    Cell: 928.814.9404

    From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
    Sent: Wednesday, February 10, 2016 7:12 PM
    To: Kathryn Good
    Subject: Re: [cdi_talk] sequencing

    Yes, the GI bleed is acute, the syndrome chronic. The GI bleed should be considered for pdx.

    Sent from my BlackBerry 10 smartphone.
    From: CDI Talk
    Sent: Wednesday, February 10, 2016 7:04 PM
    To: gwojo@wowway.com
    Reply To: cdi_talk@hcprotalk.com
    Subject: [cdi_talk] sequencing


    Hi all,
    I have a VERY complex patient with a very long LOS. Pt had laryngeal ca but presented with acute kidney failure, GI bleed, resp failure, etc. GI bleed resolved within first week but pt continues to be tenuous. CHF, ATN, etc. Initially thrombocytopenia was thought to be due to Plavix. Day 12 he has recurrent bleed, duodenal, which is cauterized. Thrombocytopenia worsens as does renal failure. HD is intiated and workup continues. He continues to re-bleed. Hemostatic clips placed in repeat EGD. Eventually he is diagnosed with Atypcial hemolytic-uremic syndrome.

    Currently the duodenal clips are the DRG driving procedure but the coder had the hemolytic-uremic syndrome as Pdx which puts us in DRG 981. Is this sequencing correct or should the duodenal ulcers (bleeding) be Pdx putting us in DRG 326 (stomach, esoph, duodenal procedures)

    Katy Good, RN, BSN, CCDS, CCS
    Clinical Documentation Program Coordinator
    Flagstaff Medical Center
    Kathryn.Good@nahealth.com
    Cell: 928.814.9404


    ---

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