Acute Renal Failure / Post Traumatic
Hi all, When perusing the 3M coding system checking out Renal failure, I came across the post traumatic que...as a cause of injury ..adverse effect of drug.. My question is..as a secondary dx...If a patient comes in with an elevated creatinine, decreased gfr (significantly from baseline) for greater then 24 hours...without significant improvement...noted patient to have been on nephrotixic drugs..which are now DC'd ...would this be appropriate to use..please note this leads to an MCC... providing of course physcian documents. Have been looking for ATN in the past but this seems appropriate to me..thanks for any input.
Diane Arneson RN BSN CCDS
Methodist Hospital
Diane Arneson RN BSN CCDS
Methodist Hospital
Comments
Renal failure due to a drug would be coded to adverse effect of that drug and a code for the type of renal failure documented by MD.
Sharon Salinas, CCS
Barlow Respiratory Hospital
213-250-4200 Extension 3336
Diane Arneson RN BSN CCD
Methodist Hospital
I was just talking to a physician about this yesterday and if you use the
book as a resource you are in "crushing injury" for traumatic anuria. I
hate to say this but I talked this over with the Coding Educator and our
Lead Coder and it might be a 3M grouper issue which takes you to adverse
effect of drug.
Would love to hear what others think ....
Gail
Trauma Code.
If a form of renal failure is stated as due to the adverse effect of a
properly prescribed and used drug, 958.5 is not used, but the form of
renal failure attributed to the adverse effect of the drug is used -
something from the 584.X series would be used to described 'acute'
failure due to the drug.
E-codes would be assigned as secondary codes to describe the
circumstances. This is not a full description of all scenarios
describing 'poisoning' versus 'adverse effect' of drugs. The Official
Guidelines cover this nicely.
Paul
Paul Evans, RHIA, CCS, CCS-P, CCDS
Supervisor, Clinical Documentation Integrity, Quality Department
California Pacific Medical Center
2351 Clay #243
San Francisco, CA 94115
Cell: 415.637.9002
Fax: 415.600.1325
Ofc: 415.600.3739
evanspx@sutterhealth.org
Always, always, ALWAYS go back to the ICD9 manual when in doubt.
For the original question -- is part of the problem that what was documented was Acute Kidney Injury due to drug toxicity? If there is no trauma, then one must NOT follow that line of thought in 3M -- since you know that is not factually accurate.
Don
automated coding system generates an incorrect code.
The best way to verify code assignment is to use a current copy of a
coding book.
Paul Evans, RHIA, CCS, CCS-P, CCDS
Supervisor, Clinical Documentation Integrity, Quality Department
California Pacific Medical Center
2351 Clay #243
San Francisco, CA 94115
Cell: 415.637.9002
Fax: 415.600.1325
Ofc: 415.600.3739
evanspx@sutterhealth.org
Couldn't have said it better
: )
Gail
One has to be aware and choose the most accurate option when following
any logic tree.
You get there from here based on the user's choice of options. In this
case, choosing 'post traumatic' does not seem to be the most appropriate
choice and it takes you down the wrong path. When a traumatic code is
chosen, the logic tree will take you to the complete list of E-codes
where adverse effect is a choice. However you got there by picking an
incorrect option. You have to start with the appropriate choice to get
to the right place. In this case, adverse effect is the correct
starting point.
It's kind of like trying to get to a particular location. You have to
start out get on the right street first. Then to an intersection with
right and left turn lanes as well as a 'go straight' lane. If your
destination is straight ahead but you choose to follow the right turn
lane, you are not going to get where you want to go without taking a few
more turns or going back to the intersection again and making the
correct choice.
Sharon
Diane Arneson
Methodist Hospital