Respiratory failure vs. sepsis sequencing in expired patient
Help!
I have a patient who came into ED from a "workshop" who had aspirated. He had documented "profound" Resp failure and was immediately intubated in ED. He subsequently died. (I also have the diagnoses of Sepsis and Aspiration Pneumonia).
I used RESP FAILURE as my PDX and DRG 208 with mortality of 25.4%. The coder is telling me Sepsis "has to-in her understanding" be sequenced first. Her DRG 871 w mortality 14.8.
I have explained Sepsis only HAS to the sequenced prior to the actual infection, but per coding guidelines, the resp failure meets criteria to be PDX, and since my pt died I really want to capture the greatest mortality-and the documentation and clinical picture of the patient supports this.
Input? Help?
Thanks in advance!
I have a patient who came into ED from a "workshop" who had aspirated. He had documented "profound" Resp failure and was immediately intubated in ED. He subsequently died. (I also have the diagnoses of Sepsis and Aspiration Pneumonia).
I used RESP FAILURE as my PDX and DRG 208 with mortality of 25.4%. The coder is telling me Sepsis "has to-in her understanding" be sequenced first. Her DRG 871 w mortality 14.8.
I have explained Sepsis only HAS to the sequenced prior to the actual infection, but per coding guidelines, the resp failure meets criteria to be PDX, and since my pt died I really want to capture the greatest mortality-and the documentation and clinical picture of the patient supports this.
Input? Help?
Thanks in advance!
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