Coding Scenarios
How would you code this patient?
- 78 y.o. female with right sided lung mass
- Patient has lost 27 lbs. In last 3 months even though she has not changed her eating habits; her BMI is 17
- With the weight loss, mass and history of cancer, physician believes this is likely mets from breast cancer the patient had 5 years ago
- Patient received right mastectomy at that time and cancer was believed to have been eradicated; she has refused any further diagnostic testing and has elected to go with hospice care
Click here to reveal the answer
Answer:
R91.8, R63.5, Z68.1, Z85.3, Z90.11Rationale : The physician states that lung cancer is “likely” and no further diagnostics are to be done. This leaves us unable to code the lung mass as cancer. Any additional dx that are contributing to the patient’s terminal status should be coded. The physician believes the cancer is mets from the patient’s previous breast cancer, so this history is also important to code.
Tip : Due to nonspecific primary/terminal dx, detailed documentation is key to getting patient covered.
How would you code this patient?
- 70 y.o. patient admitted to hospice with a terminal diagnosis of unspecified dementia
- Patient has a history of CVA with right sided hemiplegia, HTN and oral-pharyngeal dysphagia
- Patient has had a very poor appetite over the last 3-4 months and has lost 20 lbs.; his BMI is 19
Click here to reveal the answer
Answer:
Patient is not able to be coded with the information we haveRationale : Unspecified dementia is not permitted as a hospice primary/terminal diagnosis.
Tip : Coder would need to contact the physician/hospice medical director to determine if this is vascular dementia r/t to the CVA or Alzheimer’s type dementia. If the specific type of dementia has not been diagnosed, senile degeneration of the brain is an acceptable primary if the physician agrees.
How would you code this patient?
- 80 y.o patient is admitted with a terminal diagnosis of acute systolic heart failure
- Patient also has a history of systolic heart failure, HTN and CKD stage 2
- Patient is short of breath and requires continuous oxygen
- Patient also has had a very poor appetite for the past several weeks
Click here to reveal the answer
Answer:
I13.0, I50.23, N18.2, R63.0, Z99.81Rationale : The “with” convention presumes a causal relationship between HTN, CHF and CKD even if the provider does not. The etiology/manifestation convention (“code first”, “use additional code”) tells us that the I13.0 must go before the I50.23 and the N18.2. We don’t code the shortness of breath because it is an inherent symptom to CHF.
How would you code this patient?
- 67 y.o. was admitted to hospice following an acute CVA causing severe oropharyngeal dysphagia and right sided hemiplegia
- Patient refused a feeding tube
- Patient has a history of HTN
Reveal the answer
Answer:
I69.391, R13.10, I69.351, I10Rationale : Sequela (late effects) of stroke should be coded in hospice. It is only appropriate to code an acute CVA if the patient has a current bleed that has not stopped, or the bleed is not being treated, according to Coding Clinic.
Please note that all scenarios are fictional and have been created for educational purposes only.
Resources
See MatrixCare in action
Start by having a call with one of our experts to see our platform in action.
MatrixCare offers industry-leading software solutions. Thousands of facility-based and home-based care organizations trust us to help them improve efficiency and provide exceptional care.
© MatrixCare is a registered trademark of MatrixCare. All rights reserved.