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Effective Coding Under MS-DRGs Notes/Comments/Questions Hypercoagulable Syndrome - CC Association with DVT • Manifestation • Phlegma cerulea dolens • Pulmonary Embolus • Deep venous Thrombosis • Underlying cause • Virchow’s Triad – 1° or 2° Hypercoagulability; Thrombophlebitis; Stasis Usually present on admission – Estrogen Use, Cancer, Pregnancy Still to be ruled out - Factor V Leiden, Protein C deficiency, Protein S deficiency – As primary hypercoagulability • Instigating Cause – recent surgery, pregnancy, underlying cancer, drug use (e.g. hormones) If patients are on chronic Coumadin ® , warfarin, or heparin, inquire if patient has hypercoaguable syndrome 53 Deleted CC Uncontrolled Diabetes • Still needs to be captured • Dr. Kennedy defines this as: • Multiple Blood Glucoses over 250 mg/dl requiring changes in therapeutic regimen • One fasting Blood Glucose over 300 mg/dl • Recurrent hypoglycemia requiring multiple changes in therapeutic regimen • Hgb A lC over 7.0 54 AHIMA 2008 Audio Seminar Series 27 CPT ® Codes Copyright 2007 by AMA. All Rights Reserved
Effective Coding Under MS-DRGs Notes/Comments/Questions Diabetic Ketoacidosis - MCC 250.1x w/o Coma; 250.3x w/Coma • Results from complete deficiency of insulin AND excessive counter regulatory hormone excess • Hyperglycemia (300-600) • Ketosis (4+ Plasma Ketones, 1:8 or greater) • Diagnosis • Patient very dehydrated - Acute Renal Failure 2° Dehydration? • Kussmaul breathing, fever, possibly coma - MCC • Hyperglycemia and Ketosis • Metabolic Acidosis (pH 6.8-7.3, HCO 3 < 15 meq/L, “elevated anion gap” • Serum Potassium usually high due to acidosis; if normal, patient very depleted. • Treatment can lead to cerebral edema Patients with DKA invariably are Type 1 (but can be Type 2) and uncontrolled; Coding Clinic 3 rd Quarter, 2006, directs DKA to be coded with a fifth digit of “3” unless MD states it is Type 2 diabetes 55 Nonketotic Hyperosmolar State – MCC • Primarily in Type 2 Diabetics • Associated with absolute or relative insulin deficiency • Just enough insulin to prevent ketoacidosis, but not enough to prevent hyperglycemia • Results in profound dehydration, hyperglycemia, and hyperosmolality (330-380) • Blood glucose usually over 600 • ?Acute Renal Failure 2° Dehydration? • pH is normal or slightly decreased due to dehydration • HCO 3 usually normal • Creatinine moderately elevated due to dehydration. • Treated with rehydration with isotonic/hypotonic saline and small doses of insulin; removal of underlying cause Patients with NKHS invariably are Type 2 and uncontrolled; but, unlike DKA, the physician must state that a patient is uncontrolled. 56 AHIMA 2008 Audio Seminar Series 28 CPT ® Codes Copyright 2007 by AMA. All Rights Reserved
Page 1 and 2: Effective Coding Under MS-DRGs Audi
Page 3 and 4: Faculty Sharalyn Milliken, RN, JD,
Page 5 and 6: Table of Contents Deleted CC - Chro
Page 7 and 8: Effective Coding Under MS-DRGs Note
Page 31: Effective Coding Under MS-DRGs Note
Page 43 and 44: Appendix DRG Documentation Tips ...
Page 45 and 46: Definition of Terms: Acute Respirat

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