Title: Systemic Inflammatory Response Syndrome (SIRS) due to Pancreatitis
The questioner asked for clarification of the advice published in First Quarter 2010. In that issue, coders were instructed to assign code 995.93, Systemic inflammatory response syndrome due to noninfectious process without acute organ dysfunction for SIRS due to a noninfectious condition, such as pancreatitis. Because the etiology of pancreatitis can either be infectious or noninfectious, the questioner asked if the provider be queried.
Title: Borderline Diabetes Mellitus
The question of coding a diagnosis of borderline diabetes was posed.
If not, a diagnosis of “borderline diabetes” without further confirmation of the disease should be assigned the appropriate code from subcategory 790.2, Abnormal glucose.
Title: Chronic Venous Embolism and Thrombosis
The questioner noted that there were codes for chronic venous embolism and thrombosis, and asked when DVT becomes chronic.
Title: Broken Catheter Tip Retrieved via Thrombectomy
The questioner noted that a patient was admitted for thrombosed arteriovenous graft. An aspiration of thrombus was performed. During the procedure, the catheter tip separated at the entry site of the sheath after access through scar tissue. Open thrombectomy was performed with retrieval of the catheter tip. What is the code assignment for the broken catheter tip?
If the catheter tip had not been retrieved, codes 996.1, Mechanical complication of other vascular device, implant, and graft, and 998.4, Foreign body accidentally left during a procedure, would be assigned.
Note there is a previous
Coding Clinic, First Quarter 1995, with an example of a catheter tip that broke off during chemotherapy infusion.
Title: Broken Needle Left during Surgery
The questioner asked about a needle placed along the right lateral aspect of the sewing ring of the aortic valve and passed through tissue to try to cinch the valve down. The suture broke from the needle and the needle was lost within this tissue. An x-ray was done which did not reveal the needle. The chest was closed and a second x-ray showed that the needle was to the right of the aortic valve. The chest was reopened but the needle still could not be located or palpated.
The surgeon decided that continuing to look for the needle was likely to cause the patient more harm than good. Therefore, the chest was closed again, and the patient was transferred to ICU in stable condition.
The questioner asked what the correct diagnosis code assignment is when a provider intentionally leaves a foreign body in the patient and the documentation clearly states that removing the foreign body will cause more harm than good? Would code 998.4, Foreign body accidentally left during procedure, be appropriate?
Coding for Home Health Care
The questioner asked if symptoms codes should be assigned along with the aftercare codes. As an example, they asked if it was appropriate to assign a code for gait abnormality when a patient is receiving home health aftercare following joint replacement? Does the advice change depending on whether this is an outpatient encounter versus an inpatient admission?
Title: Code Assignment Based on Up and Down Arrows
The questioner asked if it was appropriate to assign a diagnosis code for a condition listed with up and down arrows? Examples were provided: ↑ cholesterol, or ↑lipids, or ↓hemoglobin and hematocrit, and they wondered if a code should be assigned for hypercholesterolemia, or hyperlipidemia, or low H&H, etc.? They also wondered if the advice changed depending on whether this is an outpatient encounter versus an inpatient admission?
The use of up and down arrows can have variable interpretations and do not necessarily mean “abnormal.” They could simply be indicating change (including improvement) over past results. Therefore the provider should be queried regarding the meaning of the arrows and request that the appropriate documentation of a condition or diagnosis be provided.
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