Principal Diagnosis with a POA of No
Does that happen sometimes??
Example: Patient presented with abd pain- documentation of SBO vs. ileus. Further study determines patient had diverticulitis. Bowel perforation occurs on day 4 of admission and pt goes to OR.
My principal diagnosis is K5720 diverticulitis with perforation and a POA status of No? TY!
Comments
Our Coding Department sends charts to a third party auditor and this has happened before. It was a GI case either perforation and/or bleeding combo code. I'll have to see if I can dig up the example. They had to do some convincing with me but I finally decided they were right :-)
Jeff
I think there is a rule that if any part of a combo code that is not POA, the entire thing is coded as not POA. In this case, I think the diverticulitis was present on admission but the perforation was not.
I recently had a discussion with our Coding department about a similar situation and they were OK with a POA of no with a combo code diagnosis.
Yes, diverticulitis was present on admission but the perforation did not occur until day 4. Coding guidelines page 119
Codes That Contain Multiple Clinical Concepts Assign "N" if at least one of the clinical concepts included in the code was not present on admission (e.g., COPD with acute exacerbation and the exacerbation was not present on admission; gastric ulcer that does not start bleeding until after admission; asthma patient develops status asthmaticus after admission). Assign "Y" if all of the clinical concepts included in the code were present on admission (e.g., duodenal ulcer that perforates prior to admission).Our patient admitted with AKI and a superficial cellulitis infection. Treated with vanco for the cellulitis. Developed Vancomycin Toxicity, which led to ATN. Combo code for AKI w/ATN coded "No" for POA. AKI was POA, ATN was not. AKI was PDx. Thoughts about this code as PDx?