Effective Coding Under MS-DRGs - American Health Information ...

Effective Coding Under MS-DRGs
Notes/Comments/Questions
Deleted CC – Hypovolemia
Alternative: Acute Renal Failure (MCC)
If there is a change of the serum creatinine
of ± 0.3 – 0.5 mg/dl in the hospitalization,
consider acute renal failure
Biomarker: NGAL, Cystatin-C, IL-18 under
consideration
An abrupt (within 48
hours) reduction in kidney
function currently defined
as an absolute increase in
SCr of =0.3 mg/dl, a
percentage increase in
SCr of = to 50% (1.5-fold
from baseline), or a
reduction in urine output
(documented oliguria of
less than 0.5 ml/kg per
hour for more than six
hours).
Mehta, et. al. the Acute Kidney Injury Network et al. Critical Care 2007 11:R31
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Electrolyte Imbalances
• Hyponatremia (CC)
• SIADH (CC)
• Metabolic encephalopathy (MCC)
• Hyperkalemia (Not a CC)
• Hypoaldosteronism (CC)
• ACE-Inhibitors, Angiotensin
Receptor Blockers, Spironolactone
• CKD Stage IV-V (CC)
• ESRD (MCC)
• Hypercalcemia (Not a CC)
• Metabolic encephalopathy (MCC)
• Acidosis (CC) HCO 3 28
Query –
Please describe the
precise underlying
etiologies/ mechanisms
of this patient’s
hyponatremia/
hypokalemia.
What are the
consequences of this
patient’s chronic illness?
Exactly how did
hyponatremia or
hypercalcemia cause this
patient’s confusion?
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AHIMA 2008 Audio Seminar Series 23
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