Change in mandate to code first Code J44.0 CDOP with acute lower respiratory infection,

We just had our ICD 10 update on the new code. J 44.0 was brought up as a code with a change in mandate. The educator stated that the mandate to code first the J44.0 COPD with lower resp infection has been changed. Either condition might be principal depending on circumstance of admission.  Are we to understand that Pneumonia could be the PDX if it meets the clinical criteria for Principal diagnosis? 

Comments

  • That's how we interpret it.  Wish we could go back and recoup what we lost with this debacle.
  • AMEN!  Debacle indeed.
    HALLELUJAH!  Pneumonia can be PDx when appropriate.
    : )
  • where do you find that change? I'm not seeing it.
    Thanks
  • Section I. A. 17.

    “Code also” note

    A “code also” note instructs that two codes may be required to fully describe a condition, but this note does not provide sequencing direction. The sequencing depends on the circumstances of the encounter.

  • I am still very confused on this.. I just watched the HCPRO Webinar Just Coding 2018 updates to ICD-10 CM, and the presenter specifically referenced this Code Also note, and said sequencing of Pneumonia and COPD will depend on circumstances of admission.. which is great!

    I asked our consultant group what they thought about this, and they said this is referring to either sequencing the J44.1 or the J44.0 based on circumstances of admission. This does not mean Pneumonia or COPD could be sequenced first based on circumstances of admission??

    When coding these in the Encoder, I'm still seeing this Nosology Edit: Sequencing of the codes reported should be in the following order: J44.0, J18.9..? Why are we still getting this edit if the above is true after 10/1?

    Appreciate any feedback on this?

    Thank you,

    Brittany Lopez

  • Brittany,

    Your consultants say the "Code also" note refers to sequencing J440 and J441?  I don't think so - the J440 note says "Code also to identify the infection", which has nothing to do with whether or not there was a COPD exacerbation.  And J441 does not have a "Code also" note.  

    I tried it out on our encoder and I see that Nosology Edit to put COPD before PNA, too.  ??!   Does anyone know why?

    Jeanne McCorkle, BSN, RN, CCDS
  • Brittany,

    Your consultants say the "Code also" note refers to sequencing J440 and J441?  I don't think so - the J440 note says "Code also to identify the infection", which has nothing to do with whether or not there was a COPD exacerbation.  And J441 does not have a "Code also" note.  

    I tried it out on our encoder and I see that Nosology Edit to put COPD before PNA, too.  ??!   Does anyone know why?

    Jeanne McCorkle, BSN, RN, CCDS


    Jeanne...we are just getting our 10/1 3M update this pm, have you received yours yet? Will be interesting to see if we get that edit tomorrow.

    Jeff

  • We updated last Friday ... and the edit is still there
  • We updated last Friday ... and the edit is still there

    Well, there goes that theory!
  • While the edit is still there in the encoder, if you look at the index entry at J44.0 it now says to "code also to identify the infection". "Code also" - sequencing depends on the circumstances of the encounter. I believe this is why we can now pick pneumonia as the principal diagnosis when the patient also has COPD.

    Allen Frady does a great job of explaining this in the ACDIS blog.

    Maria

  • I do NOT have a 2018 Code Book, but, I'd say the book and its instructions takes precedence over any software or encoder.   


    Paul

  • I have never been so excited about a coding instructional change. This one in particular I disliked so I was happy to know it was updated.

  • When a person with copd (on outpt inhaled steroid, rescue inhaler, nite & prn O2) is admitted for treatment of simple PNA (no SCx or dysphagia) and there is NO MCC - What is the PDX?  

    No exacerbation of copd.  Both J44.0 and J18.9 are POA. If PNA is the PDX, the DRG is 194 (w/ cc); if COPD w/ L RTI is PDX, the DRG 190 (w/ mcc). The reimbursement is better in DRG 190.  Both are treated and POA.

    What do you think the PDX is?  DRG 194 (less $$) or DRG 190 (more $$)?

    I was elated when the 2018 Update announced the change in mandate: finally we can choose PNA when we have COPD w/ L RTI & and an MCC!!   but...

    Sequencing language ‘circumstances of the admission’ can be problematic. Coders can choose DRG 193, using the “circumstances of the admission” language, and CDI can choose DRG 190, using the “circumstances of the admission language (or visa versa).  So what is answer: What is the PDX ?

    Rarely would documentation say ‘copd w/ LRTI, PNA POA’ - is this the standard required to sequence DRG 190 as PDX for those wanting DRG 194? I want to understand this...it never made sense to me before the 2018 Update change. 
  • Abanchy said:
    When a person with copd (on outpt inhaled steroid, rescue inhaler, nite & prn O2) is admitted for treatment of simple PNA (no SCx or dysphagia) and there is NO MCC - What is the PDX?  

    No exacerbation of copd.  Both J44.0 and J18.9 are POA. If PNA is the PDX, the DRG is 194 (w/ cc); if COPD w/ L RTI is PDX, the DRG 190 (w/ mcc). The reimbursement is better in DRG 190.  Both are treated and POA.

    What do you think the PDX is?  DRG 194 (less $$) or DRG 190 (more $$)?

    I was elated when the 2018 Update announced the change in mandate: finally we can choose PNA when we have COPD w/ L RTI & and an MCC!!   but...

    Sequencing language ‘circumstances of the admission’ can be problematic. Coders can choose DRG 193, using the “circumstances of the admission” language, and CDI can choose DRG 190, using the “circumstances of the admission language (or visa versa).  So what is answer: What is the PDX ?

    Rarely would documentation say ‘copd w/ LRTI, PNA POA’ - is this the standard required to sequence DRG 190 as PDX for those wanting DRG 194? I want to understand this...it never made sense to me before the 2018 Update change. 

    Based on what is described, PDX assignment should be pneumonia. I cannot see any circumstance where stable (no exacerbation) COPD meets criteria for hospital admission, neither observation or inpatient, therefore would not meet UHDDS definition of principal diagnosis. 

    Now, when both COPD exacerbation and pneumonia are both POA, both requiring acute treatment (IV antibiotics, IV steroids, frequent nebulizer treatments, oxygen, failure to respond quickly in the ER), then J44.1 may meet definition of PDX. 



    Hope that helps.

    -Richard
  • Agree - that is exactly what I said BEFORE the 2018 mandate change (having been case coordinator/ UR ), which is why it made no sense to me THEN to have to use COPD w/ LRTI as the PDX in this circumstance (PNA, no copd exac) and be stuck in a limited DRG. However, that 'logic' (Pre-Mandate) has not changed Post- mandate - it just gives you a choice, to select either.  So why choose to loose money, when you don't have an MCC with a PNA pdx?

    Stable COPD with Acute Bronchitis (DRG 191)- Stable COPD with PNA (DRG 190)...both are COPD w/ LRTI and both will meet criteria for admit, especially in immunocompromised patients or end-stage COPD, or valvular HD (had one today, current lung mets s/p lobectomy, 24/7 O2, bit of AKI....no sepsis) 4 day stay. Sorry, don't have my InterQual handy, but iv abx, nebs, hydration...

    Is DRG 190  subject to readmission penalties (like PNA)?  Does LOS have a role in the decision, or perhaps Transfer DRGs?
Sign In or Register to comment.