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Effective Coding Under MS-DRGs Notes/Comments/Questions Other CC Alternatives with Diabetes • Autonomic Neuropathy - CC • Reason for using Viagra • Florinef used to fight orthostatic hypotension • Neurogenic Bladder - CC • Chronic Kidney Disease - CC • Stage 4 or 5 (Creatinine over 2.0 – 2.5 mg/dl) • ESRD – MCC – on dialysis • Diabetic Nephrosis – Nephrotic Syndrome • 4+ protein (over 3 grams per day) • Hypoalbumemia • Hyperlipidemia • Associated with Chronic Kidney Disease • Insulin Coma - MCC • Not just “hypoglycemia” 57 “Altered Mental Status” • M and S – What type of Altered Mental Status? • ACUTE Delirium, Dementia, Stupor, Coma, Mania, Confusion, Psychosis (CC) , Hallucinations (CC) , Delusions (CC) • U – Underlying Cause • Encephalopathy (MCC) – Toxic, Septic, Metabolic; • Alzheimer's Disease – must describe delusional/depressed/or psychosis – behaviorial changes – to be a CC • Normal Pressure Hydrocephalus – (CC) – has a shunt in place • Multi-infarct Dementia (CC) – Late effect of stroke (no CC) • Lewy-Body Dementia (associated with Parkinson’s Disease); • Bipolar Disorder (CC) • Specified schizophrenia (CC) • Drug withdrawal (CC) • Seizure – Concussion • Stroke (MCC) – TIA (CC) 58 AHIMA 2008 Audio Seminar Series 29 CPT ® Codes Copyright 2007 by AMA. All Rights Reserved
Effective Coding Under MS-DRGs Notes/Comments/Questions Encephalopathy • A diffuse disease of the brain secondary to an otherwise nondefined neurological or a defined nonneurological illness or insult • Multiple types in ICD-9-CM • Metabolic – due to metabolic issues • Septic – due to sepsis • Toxic – due to drugs • Anoxic – due to lack of oxygen • Hypoglycemic – due to hypoglycemia • Hypertensive – due to malignant hypertension Coding Clinic References: “(Toxic) metabolic encephalopathy refers to an altered state of consciousness, usually denoting delirium.” - CC 4 th Q 1993 p. 29 “Metabolic encephalopathy is always due to an underlying cause, seen in 12-33% of patients with organ failure – CC 4 th Q 2003, p. 58-59 59 TIA vs. Stroke as CC/MCC • “TIA” (a CC) – Transient Neurological Symptoms due to ischemia LASTING LESS THAN ONE HOUR and no evidence of Stroke (e.g. MRI, CT Scan) • “Stroke” (a MCC) – Neurological symptoms • due to ischemia with evidence of stroke on neuroimaging • If symptoms >1 hour, 85% chance of stroke • Aborted stroke coded as a stroke • Consequences (if a stroke – present on DC) • 344.1 – Paraplegia (CC) • 344.61 – Neurogenic Bladder (CC) • 348.4 – Cerebral herniation (MCC) • 348.5 - Cerebral edema (MCC) • 784.1 – Transient limb paralysis (CC) • 784.3 – Aphasia (CC) • 781.8 – Neurologic Neglect Syndrome (CC) Code neurologic deficits of stroke on discharge? Source: Sacco, et. al. Stroke, 37 (2): 577. (2006) 60 AHIMA 2008 Audio Seminar Series 30 CPT ® Codes Copyright 2007 by AMA. All Rights Reserved
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Effective Coding Under MS-DRGs - American Health Information ...

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