Rhabdomyolysis
Hello.
Reaching out for some guidance related to sequencing Rhabdomyolysis and AKIw/CKD.
Scenario: Patient admitted with Rhabdomyolysis and AKI.
DC summary states "Acute-on-Chronic kidney injury likely secondary to rhabdomyolysis possibly secondary to Zocor use" other conditions listed are CKD stage IV, type 2 DM, UTI. Patient required dialysis catheter placement and received hemodialysis while inpatient. Nephrology recommended that the patient will need to be placed on chronic dialysis...
Which would be principle: Rhabdomyolysis or AKI or other?
Thank you for any input.
Angie Guiler RN
Clinical Documentation Specialist
angie.guiler@bergerhealth.com
Berger Health System
600 N. Pickaway Street, Circleville, OH 43113
(740) 420-8177 Direct
(740) 474-2126 Phone
(740) 420-8644 Fax
www.bergerhealth.com
Care first. Community always.
Reaching out for some guidance related to sequencing Rhabdomyolysis and AKIw/CKD.
Scenario: Patient admitted with Rhabdomyolysis and AKI.
DC summary states "Acute-on-Chronic kidney injury likely secondary to rhabdomyolysis possibly secondary to Zocor use" other conditions listed are CKD stage IV, type 2 DM, UTI. Patient required dialysis catheter placement and received hemodialysis while inpatient. Nephrology recommended that the patient will need to be placed on chronic dialysis...
Which would be principle: Rhabdomyolysis or AKI or other?
Thank you for any input.
Angie Guiler RN
Clinical Documentation Specialist
angie.guiler@bergerhealth.com
Berger Health System
600 N. Pickaway Street, Circleville, OH 43113
(740) 420-8177 Direct
(740) 474-2126 Phone
(740) 420-8644 Fax
www.bergerhealth.com
Care first. Community always.
Comments
Does the physician documentation from the ER or in the H&P give any hints about what they were thinking necessitated admit?
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
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Thursday, February 18, 2016 12:55 PM
To: Vanessa Falkoff
Subject: [cdi_talk] Rhabdomyolysis
Hello.
Reaching out for some guidance related to sequencing Rhabdomyolysis and AKIw/CKD.
Scenario: Patient admitted with Rhabdomyolysis and AKI.
DC summary states "Acute-on-Chronic kidney injury likely secondary to rhabdomyolysis possibly secondary to Zocor use" other conditions listed are CKD stage IV, type 2 DM, UTI. Patient required dialysis catheter placement and received hemodialysis while inpatient. Nephrology recommended that the patient will need to be placed on chronic dialysis...
Which would be principle: Rhabdomyolysis or AKI or other?
Thank you for any input.
Angie Guiler RN
Clinical Documentation Specialist
angie.guiler@bergerhealth.com
Berger Health System
600 N. Pickaway Street, Circleville, OH 43113
(740) 420-8177 Direct
(740) 474-2126 Phone
(740) 420-8644 Fax
www.bergerhealth.com
Care first. Community always.
---
CDI Talk is offered for networking purposes. For official rules and regulations related to documentation and coding, please refer to your regulatory source.
You are receiving this message as a member of CDI Talk as: vanessa.falkoff@umcsn.com
If you would like to be removed from CDI Talk, please send a blank email to
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Copyright 2013
HCPro, Inc., 75 Sylvan Street, Danvers MA 01923
The day following admission is when Acute on chronic kidney disease is mentioned as well as the Rhabdo
Angie Guiler RN
Clinical Documentation Specialist
angie.guiler@bergerhealth.com
Berger Health System
600 N. Pickaway Street, Circleville, OH 43113
(740) 420-8177 Direct
(740) 474-2126 Phone
(740) 420-8644 Fax
www.bergerhealth.com
Care first. Community always.
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Thursday, February 18, 2016 4:00 PM
To: Angie Guiler
Subject: RE:[cdi_talk] Rhabdomyolysis
Hi Angie,
Does the physician documentation from the ER or in the H&P give any hints about what they were thinking necessitated admit?
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
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Thursday, February 18, 2016 12:55 PM
To: Vanessa Falkoff
Subject: [cdi_talk] Rhabdomyolysis
Hello.
Reaching out for some guidance related to sequencing Rhabdomyolysis and AKIw/CKD.
Scenario: Patient admitted with Rhabdomyolysis and AKI.
DC summary states "Acute-on-Chronic kidney injury likely secondary to rhabdomyolysis possibly secondary to Zocor use" other conditions listed are CKD stage IV, type 2 DM, UTI. Patient required dialysis catheter placement and received hemodialysis while inpatient. Nephrology recommended that the patient will need to be placed on chronic dialysis...
Which would be principle: Rhabdomyolysis or AKI or other?
Thank you for any input.
Angie Guiler RN
Clinical Documentation Specialist
angie.guiler@bergerhealth.com
Berger Health System
600 N. Pickaway Street, Circleville, OH 43113
(740) 420-8177 Direct
(740) 474-2126 Phone
(740) 420-8644 Fax
www.bergerhealth.com
Care first. Community always.
---
CDI Talk is offered for networking purposes. For official rules and regulations related to documentation and coding, please refer to your regulatory source.
You are receiving this message as a member of CDI Talk as: vanessa.falkoff@umcsn.com
If you would like to be removed from CDI Talk, please send a blank email to
leave-cdi_talk-12881172.0567913f3a65957e70b98241bedfe64e@hcprotalk.com
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Copyright 2013
HCPro, Inc., 75 Sylvan Street, Danvers MA 01923
---
CDI Talk is offered for networking purposes. For official rules and regulations related to documentation and coding, please refer to your regulatory source.
You are receiving this message as a member of CDI Talk as: angie.guiler@bergerhealth.com
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Copyright 2013
HCPro, Inc., 75 Sylvan Street, Danvers MA 01923
The third quarter of 2002 Coding Clinic clarifies the proper code assignment of acute renal failure due to rhabdo. This advice supersedes the Coding Clinic advice found in the 2nd Quarter 2001 in which the guidance was to assign the rhabdo, ICD-9 code 728.89 as principal diagnosis with acute renal failure, ICD-9 584.9, as secondary diagnosis. Instead, the acute renal failure is to be assigned as principal diagnosis with rhabdo as secondary, provided the documentation and circumstances of admission support the same. Keep in mind that acute renal failure is an "unspecified code." If the physician documented a more specific diagnosis such as acute tubular necrosis, a specified acute renal failure, this diagnosis would be sequenced as principal diagnosis.
http://health-information.advanceweb.com/Article/Coding-QA-Aug-30-2005.aspx
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
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Thursday, February 18, 2016 1:10 PM
To: Vanessa Falkoff
Subject: RE:[cdi_talk] Rhabdomyolysis
ER and H&P only mention rhabdo and CKD
The day following admission is when Acute on chronic kidney disease is mentioned as well as the Rhabdo
Angie Guiler RN
Clinical Documentation Specialist
angie.guiler@bergerhealth.com
Berger Health System
600 N. Pickaway Street, Circleville, OH 43113
(740) 420-8177 Direct
(740) 474-2126 Phone
(740) 420-8644 Fax
www.bergerhealth.com
Care first. Community always.
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Thursday, February 18, 2016 4:00 PM
To: Angie Guiler
Subject: RE:[cdi_talk] Rhabdomyolysis
Hi Angie,
Does the physician documentation from the ER or in the H&P give any hints about what they were thinking necessitated admit?
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
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Thursday, February 18, 2016 12:55 PM
To: Vanessa Falkoff
Subject: [cdi_talk] Rhabdomyolysis
Hello.
Reaching out for some guidance related to sequencing Rhabdomyolysis and AKIw/CKD.
Scenario: Patient admitted with Rhabdomyolysis and AKI.
DC summary states "Acute-on-Chronic kidney injury likely secondary to rhabdomyolysis possibly secondary to Zocor use" other conditions listed are CKD stage IV, type 2 DM, UTI. Patient required dialysis catheter placement and received hemodialysis while inpatient. Nephrology recommended that the patient will need to be placed on chronic dialysis...
Which would be principle: Rhabdomyolysis or AKI or other?
Thank you for any input.
Angie Guiler RN
Clinical Documentation Specialist
angie.guiler@bergerhealth.com
Berger Health System
600 N. Pickaway Street, Circleville, OH 43113
(740) 420-8177 Direct
(740) 474-2126 Phone
(740) 420-8644 Fax
www.bergerhealth.com
Care first. Community always.
---
CDI Talk is offered for networking purposes. For official rules and regulations related to documentation and coding, please refer to your regulatory source.
You are receiving this message as a member of CDI Talk as: vanessa.falkoff@umcsn.com
If you would like to be removed from CDI Talk, please send a blank email to
leave-cdi_talk-12881172.0567913f3a65957e70b98241bedfe64e@hcprotalk.com
---
Copyright 2013
HCPro, Inc., 75 Sylvan Street, Danvers MA 01923
---
CDI Talk is offered for networking purposes. For official rules and regulations related to documentation and coding, please refer to your regulatory source.
You are receiving this message as a member of CDI Talk as: angie.guiler@bergerhealth.com
If you would like to be removed from CDI Talk, please send a blank email to
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---
Copyright 2013
HCPro, Inc., 75 Sylvan Street, Danvers MA 01923
---
CDI Talk is offered for networking purposes. For official rules and regulations related to documentation and coding, please refer to your regulatory source.
You are receiving this message as a member of CDI Talk as: vanessa.falkoff@umcsn.com
If you would like to be removed from CDI Talk, please send a blank email to
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---
Copyright 2013
HCPro, Inc., 75 Sylvan Street, Danvers MA 01923
Thank you again, apologize for the multiple questions.
Angie Guiler RN
Clinical Documentation Specialist
angie.guiler@bergerhealth.com
Berger Health System
600 N. Pickaway Street, Circleville, OH 43113
(740) 420-8177 Direct
(740) 474-2126 Phone
(740) 420-8644 Fax
www.bergerhealth.com
Care first. Community always.
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Thursday, February 18, 2016 4:27 PM
To: Angie Guiler
Subject: RE:[cdi_talk] Rhabdomyolysis
I found a couple of references and this is what all seem to say:
The third quarter of 2002 Coding Clinic clarifies the proper code assignment of acute renal failure due to rhabdo. This advice supersedes the Coding Clinic advice found in the 2nd Quarter 2001 in which the guidance was to assign the rhabdo, ICD-9 code 728.89 as principal diagnosis with acute renal failure, ICD-9 584.9, as secondary diagnosis. Instead, the acute renal failure is to be assigned as principal diagnosis with rhabdo as secondary, provided the documentation and circumstances of admission support the same. Keep in mind that acute renal failure is an "unspecified code." If the physician documented a more specific diagnosis such as acute tubular necrosis, a specified acute renal failure, this diagnosis would be sequenced as principal diagnosis.
http://health-information.advanceweb.com/Article/Coding-QA-Aug-30-2005.aspx
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
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Thursday, February 18, 2016 1:10 PM
To: Vanessa Falkoff
Subject: RE:[cdi_talk] Rhabdomyolysis
ER and H&P only mention rhabdo and CKD
The day following admission is when Acute on chronic kidney disease is mentioned as well as the Rhabdo
Angie Guiler RN
Clinical Documentation Specialist
angie.guiler@bergerhealth.com
Berger Health System
600 N. Pickaway Street, Circleville, OH 43113
(740) 420-8177 Direct
(740) 474-2126 Phone
(740) 420-8644 Fax
www.bergerhealth.com
Care first. Community always.
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Thursday, February 18, 2016 4:00 PM
To: Angie Guiler
Subject: RE:[cdi_talk] Rhabdomyolysis
Hi Angie,
Does the physician documentation from the ER or in the H&P give any hints about what they were thinking necessitated admit?
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
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Thursday, February 18, 2016 12:55 PM
To: Vanessa Falkoff
Subject: [cdi_talk] Rhabdomyolysis
Hello.
Reaching out for some guidance related to sequencing Rhabdomyolysis and AKIw/CKD.
Scenario: Patient admitted with Rhabdomyolysis and AKI.
DC summary states "Acute-on-Chronic kidney injury likely secondary to rhabdomyolysis possibly secondary to Zocor use" other conditions listed are CKD stage IV, type 2 DM, UTI. Patient required dialysis catheter placement and received hemodialysis while inpatient. Nephrology recommended that the patient will need to be placed on chronic dialysis...
Which would be principle: Rhabdomyolysis or AKI or other?
Thank you for any input.
Angie Guiler RN
Clinical Documentation Specialist
angie.guiler@bergerhealth.com
Berger Health System
600 N. Pickaway Street, Circleville, OH 43113
(740) 420-8177 Direct
(740) 474-2126 Phone
(740) 420-8644 Fax
www.bergerhealth.com
Care first. Community always.
---
CDI Talk is offered for networking purposes. For official rules and regulations related to documentation and coding, please refer to your regulatory source.
You are receiving this message as a member of CDI Talk as: vanessa.falkoff@umcsn.com
If you would like to be removed from CDI Talk, please send a blank email to
leave-cdi_talk-12881172.0567913f3a65957e70b98241bedfe64e@hcprotalk.com
---
Copyright 2013
HCPro, Inc., 75 Sylvan Street, Danvers MA 01923
---
CDI Talk is offered for networking purposes. For official rules and regulations related to documentation and coding, please refer to your regulatory source.
You are receiving this message as a member of CDI Talk as: angie.guiler@bergerhealth.com
If you would like to be removed from CDI Talk, please send a blank email to
leave-cdi_talk-20325672.4ff02ea37fab4b038fabf4550c231787@hcprotalk.com
---
Copyright 2013
HCPro, Inc., 75 Sylvan Street, Danvers MA 01923
---
CDI Talk is offered for networking purposes. For official rules and regulations related to documentation and coding, please refer to your regulatory source.
You are receiving this message as a member of CDI Talk as: vanessa.falkoff@umcsn.com
If you would like to be removed from CDI Talk, please send a blank email to
leave-cdi_talk-12881172.0567913f3a65957e70b98241bedfe64e@hcprotalk.com
---
Copyright 2013
HCPro, Inc., 75 Sylvan Street, Danvers MA 01923
---
CDI Talk is offered for networking purposes. For official rules and regulations related to documentation and coding, please refer to your regulatory source.
You are receiving this message as a member of CDI Talk as: angie.guiler@bergerhealth.com
If you would like to be removed from CDI Talk, please send a blank email to
leave-cdi_talk-20325672.4ff02ea37fab4b038fabf4550c231787@hcprotalk.com
---
Copyright 2013
HCPro, Inc., 75 Sylvan Street, Danvers MA 01923
For patients with AKI due to rhabdomyolysis, coders should sequence AKI as the principal diagnosis, according to Coding Clinic, Third Quarter 2002, p. 28
http://blr.hcpro.com/content.cfm?content_id=319012
V
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Thursday, February 18, 2016 1:36 PM
To: Vanessa Falkoff
Subject: RE:[cdi_talk] Rhabdomyolysis
Looking at the coding clinic for rhabodmyolysis it appears there was 2003/4th quarter update, is that just an update to the code? Making the coding clinic you provided below still active?
Thank you again, apologize for the multiple questions.
Angie Guiler RN
Clinical Documentation Specialist
angie.guiler@bergerhealth.com
Berger Health System
600 N. Pickaway Street, Circleville, OH 43113
(740) 420-8177 Direct
(740) 474-2126 Phone
(740) 420-8644 Fax
www.bergerhealth.com
Care first. Community always.
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Thursday, February 18, 2016 4:27 PM
To: Angie Guiler
Subject: RE:[cdi_talk] Rhabdomyolysis
I found a couple of references and this is what all seem to say:
The third quarter of 2002 Coding Clinic clarifies the proper code assignment of acute renal failure due to rhabdo. This advice supersedes the Coding Clinic advice found in the 2nd Quarter 2001 in which the guidance was to assign the rhabdo, ICD-9 code 728.89 as principal diagnosis with acute renal failure, ICD-9 584.9, as secondary diagnosis. Instead, the acute renal failure is to be assigned as principal diagnosis with rhabdo as secondary, provided the documentation and circumstances of admission support the same. Keep in mind that acute renal failure is an "unspecified code." If the physician documented a more specific diagnosis such as acute tubular necrosis, a specified acute renal failure, this diagnosis would be sequenced as principal diagnosis.
http://health-information.advanceweb.com/Article/Coding-QA-Aug-30-2005.aspx
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
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Thursday, February 18, 2016 1:10 PM
To: Vanessa Falkoff
Subject: RE:[cdi_talk] Rhabdomyolysis
ER and H&P only mention rhabdo and CKD
The day following admission is when Acute on chronic kidney disease is mentioned as well as the Rhabdo
Angie Guiler RN
Clinical Documentation Specialist
angie.guiler@bergerhealth.com
Berger Health System
600 N. Pickaway Street, Circleville, OH 43113
(740) 420-8177 Direct
(740) 474-2126 Phone
(740) 420-8644 Fax
www.bergerhealth.com
Care first. Community always.
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Thursday, February 18, 2016 4:00 PM
To: Angie Guiler
Subject: RE:[cdi_talk] Rhabdomyolysis
Hi Angie,
Does the physician documentation from the ER or in the H&P give any hints about what they were thinking necessitated admit?
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
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Thursday, February 18, 2016 12:55 PM
To: Vanessa Falkoff
Subject: [cdi_talk] Rhabdomyolysis
Hello.
Reaching out for some guidance related to sequencing Rhabdomyolysis and AKIw/CKD.
Scenario: Patient admitted with Rhabdomyolysis and AKI.
DC summary states "Acute-on-Chronic kidney injury likely secondary to rhabdomyolysis possibly secondary to Zocor use" other conditions listed are CKD stage IV, type 2 DM, UTI. Patient required dialysis catheter placement and received hemodialysis while inpatient. Nephrology recommended that the patient will need to be placed on chronic dialysis...
Which would be principle: Rhabdomyolysis or AKI or other?
Thank you for any input.
Angie Guiler RN
Clinical Documentation Specialist
angie.guiler@bergerhealth.com
Berger Health System
600 N. Pickaway Street, Circleville, OH 43113
(740) 420-8177 Direct
(740) 474-2126 Phone
(740) 420-8644 Fax
www.bergerhealth.com
Care first. Community always.
---
CDI Talk is offered for networking purposes. For official rules and regulations related to documentation and coding, please refer to your regulatory source.
You are receiving this message as a member of CDI Talk as: vanessa.falkoff@umcsn.com
If you would like to be removed from CDI Talk, please send a blank email to
leave-cdi_talk-12881172.0567913f3a65957e70b98241bedfe64e@hcprotalk.com
---
Copyright 2013
HCPro, Inc., 75 Sylvan Street, Danvers MA 01923
---
CDI Talk is offered for networking purposes. For official rules and regulations related to documentation and coding, please refer to your regulatory source.
You are receiving this message as a member of CDI Talk as: angie.guiler@bergerhealth.com
If you would like to be removed from CDI Talk, please send a blank email to
leave-cdi_talk-20325672.4ff02ea37fab4b038fabf4550c231787@hcprotalk.com
---
Copyright 2013
HCPro, Inc., 75 Sylvan Street, Danvers MA 01923
---
CDI Talk is offered for networking purposes. For official rules and regulations related to documentation and coding, please refer to your regulatory source.
You are receiving this message as a member of CDI Talk as: vanessa.falkoff@umcsn.com
If you would like to be removed from CDI Talk, please send a blank email to
leave-cdi_talk-12881172.0567913f3a65957e70b98241bedfe64e@hcprotalk.com
---
Copyright 2013
HCPro, Inc., 75 Sylvan Street, Danvers MA 01923
---
CDI Talk is offered for networking purposes. For official rules and regulations related to documentation and coding, please refer to your regulatory source.
You are receiving this message as a member of CDI Talk as: angie.guiler@bergerhealth.com
If you would like to be removed from CDI Talk, please send a blank email to
leave-cdi_talk-20325672.4ff02ea37fab4b038fabf4550c231787@hcprotalk.com
---
Copyright 2013
HCPro, Inc., 75 Sylvan Street, Danvers MA 01923
---
CDI Talk is offered for networking purposes. For official rules and regulations related to documentation and coding, please refer to your regulatory source.
You are receiving this message as a member of CDI Talk as: vanessa.falkoff@umcsn.com
If you would like to be removed from CDI Talk, please send a blank email to
leave-cdi_talk-12881172.0567913f3a65957e70b98241bedfe64e@hcprotalk.com
---
Copyright 2013
HCPro, Inc., 75 Sylvan Street, Danvers MA 01923
Angie Guiler RN
Clinical Documentation Specialist
angie.guiler@bergerhealth.com
Berger Health System
600 N. Pickaway Street, Circleville, OH 43113
(740) 420-8177 Direct
(740) 474-2126 Phone
(740) 420-8644 Fax
www.bergerhealth.com
Care first. Community always.
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Thursday, February 18, 2016 4:51 PM
To: Angie Guiler
Subject: RE:[cdi_talk] Rhabdomyolysis
This article is from 2015
For patients with AKI due to rhabdomyolysis, coders should sequence AKI as the principal diagnosis, according to Coding Clinic, Third Quarter 2002, p. 28
http://blr.hcpro.com/content.cfm?content_id=319012
V
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Thursday, February 18, 2016 1:36 PM
To: Vanessa Falkoff
Subject: RE:[cdi_talk] Rhabdomyolysis
Looking at the coding clinic for rhabodmyolysis it appears there was 2003/4th quarter update, is that just an update to the code? Making the coding clinic you provided below still active?
Thank you again, apologize for the multiple questions.
Angie Guiler RN
Clinical Documentation Specialist
angie.guiler@bergerhealth.com
Berger Health System
600 N. Pickaway Street, Circleville, OH 43113
(740) 420-8177 Direct
(740) 474-2126 Phone
(740) 420-8644 Fax
www.bergerhealth.com
Care first. Community always.
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Thursday, February 18, 2016 4:27 PM
To: Angie Guiler
Subject: RE:[cdi_talk] Rhabdomyolysis
I found a couple of references and this is what all seem to say:
The third quarter of 2002 Coding Clinic clarifies the proper code assignment of acute renal failure due to rhabdo. This advice supersedes the Coding Clinic advice found in the 2nd Quarter 2001 in which the guidance was to assign the rhabdo, ICD-9 code 728.89 as principal diagnosis with acute renal failure, ICD-9 584.9, as secondary diagnosis. Instead, the acute renal failure is to be assigned as principal diagnosis with rhabdo as secondary, provided the documentation and circumstances of admission support the same. Keep in mind that acute renal failure is an "unspecified code." If the physician documented a more specific diagnosis such as acute tubular necrosis, a specified acute renal failure, this diagnosis would be sequenced as principal diagnosis.
http://health-information.advanceweb.com/Article/Coding-QA-Aug-30-2005.aspx
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
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Thursday, February 18, 2016 1:10 PM
To: Vanessa Falkoff
Subject: RE:[cdi_talk] Rhabdomyolysis
ER and H&P only mention rhabdo and CKD
The day following admission is when Acute on chronic kidney disease is mentioned as well as the Rhabdo
Angie Guiler RN
Clinical Documentation Specialist
angie.guiler@bergerhealth.com
Berger Health System
600 N. Pickaway Street, Circleville, OH 43113
(740) 420-8177 Direct
(740) 474-2126 Phone
(740) 420-8644 Fax
www.bergerhealth.com
Care first. Community always.
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Thursday, February 18, 2016 4:00 PM
To: Angie Guiler
Subject: RE:[cdi_talk] Rhabdomyolysis
Hi Angie,
Does the physician documentation from the ER or in the H&P give any hints about what they were thinking necessitated admit?
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
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Thursday, February 18, 2016 12:55 PM
To: Vanessa Falkoff
Subject: [cdi_talk] Rhabdomyolysis
Hello.
Reaching out for some guidance related to sequencing Rhabdomyolysis and AKIw/CKD.
Scenario: Patient admitted with Rhabdomyolysis and AKI.
DC summary states "Acute-on-Chronic kidney injury likely secondary to rhabdomyolysis possibly secondary to Zocor use" other conditions listed are CKD stage IV, type 2 DM, UTI. Patient required dialysis catheter placement and received hemodialysis while inpatient. Nephrology recommended that the patient will need to be placed on chronic dialysis...
Which would be principle: Rhabdomyolysis or AKI or other?
Thank you for any input.
Angie Guiler RN
Clinical Documentation Specialist
angie.guiler@bergerhealth.com
Berger Health System
600 N. Pickaway Street, Circleville, OH 43113
(740) 420-8177 Direct
(740) 474-2126 Phone
(740) 420-8644 Fax
www.bergerhealth.com
Care first. Community always.
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secondary to Zocor, I would think the Rhabdo needs to be primary with
addition of the adverse reaction to the Zocor.
Although it does appear that the CKD progressed such that patient required
the insertion of the dialysis catheter and recommendation of chronic
dialysis, it is my understanding AKI can only be coded if baseline
creatinine is known and documented.
Mary Jean Valentino, RN CDS
Mary Jean Valentino
(302) 299-6327
On Thu, Feb 18, 2016 at 4:09 PM, CDI Talk wrote: