Bronchoscopy with a vented patient

rosie.mckellips@northmemorial.com rosie.mckellips@northmemorial.com
edited May 2016 in Clinical & Coding
Does anyone know why a bronchoscopy through a trach on a vented patient for removal of mucus, no mucus plugging decreases the MSDRG from vent over 96 hours to a major chest procedure with an MCC? The MD just did a quick bedside note. No biopsy was done. ???

Thank you!

Rosie McKellips, RN, RHIT, CCDS, CCS-P
Supervisor, Clinical Documentation Improvement Specialist
North Memorial Health Care and Maple Grove Hospital
763-581-4531




Comments

  • katysuegood@gmail.comkatysuegood@gmail.com
    edited May 2016
    Its taking you to a surgical DRG which takes precedence over the nonsurgical procedure (vent). What's your code? Are you coding the suctioning as extirpation of foreign body?

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



  • chj102060chj102060
    edited May 2016
    If they coded the bronchoscopy to lung instead of bronchus it goes to an OR
    procedure.


  • rosie.mckellips@northmemorial.com rosie.mckellips@northmemorial.com
    edited May 2016
    There wasn't a mucus plug so didn't use the extirpation of a foreign body. Do you use foreign body for mucus in general that is being suctioned?
    Here is the decision tree:
    Aspiration, other specified aspiration contents, respiratory system, lower lobe bronchus, through natural/artificial opening.
    0B967ZZ


  • katysuegood@gmail.comkatysuegood@gmail.com
    edited May 2016
    No. I would not code extirpation but I have seen that error made and it leads to a surgical DRG so I was curious. It looks like they are coding a drainage of R lower lobe bronchus via natural opening.
    I am not sure 'drainage' is appropriate, I haven’t seen that root operation used in this format. Mainly to drain a cyst or abscess, things like that?

    What was the intent of the procedure? Was it primarily for inspection or did they really do a bronch specifically for suction of mucous? This patient was on a vent so I am assuming they had in-line suction available so it seems somewhat strange to do a bronch just for mucous? I am wondering if this really should be an 'inspection'. Were they looking for something with the scope? Suction (in my mind) is inherent to a bronch for inspection and would not be coded separately.

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



  • rosie.mckellips@northmemorial.com rosie.mckellips@northmemorial.com
    edited May 2016
    Thanks Katy and Dr. G. I agree, bronch diagnostic would be most appropriate due to lack of other information provided or query.


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