Coding, Classification and Reimbursement

Principal Dx-POA- N

Sathya M Mohanasundaram, Master of Science in Genomics,CCS12-28-2018 02:42

Sathya M Mohanasundaram, Master of Science in Genomics,CCS12-29-2018 04:52

Sathya M Mohanasundaram, Master of Science in Genomics,CCS12-29-2018 04:56

Sathya M Mohanasundaram, Master of Science in Genomics,CCS12-31-2018 05:14

  • 1.  Principal Dx-POA- N

    Posted 12-28-2018 02:42
    Hi,

    Patient admitted for PTCA due to CAD. At the time of admission patient does not have any anginal symptoms. The next day patient developed Unstable angina which was due to thrombus of the Stent(Which was developed after PTCA). Thrombectomy was performed and patient was stabilized.
    My question is patient has already diagnosis of CAD after admission only developed unstable angina can I code I25.110 with POA status "N" as PDX?


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    Sathya Mohanasundaram
    Team Leader-IP DRG Coding
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  • 2.  RE: Principal Dx-POA- N

    Posted 12-28-2018 09:41
    if the reason for admission was the CAD, wouldn't this be the PDX?

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    Rivona Wasserman
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  • 3.  RE: Principal Dx-POA- N

    Posted 12-29-2018 04:52
    Yes CAD is the reason for admission. Little bit hesitation to code as POA N. Few of colleagues suggested to code CAD with Y and unstable angina separately with N because angina was due to thrombosis in stent.
    What's your thoughts?

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    Sathya M Mohanasundaram
    Team Leader-IP DRG Coding
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  • 4.  RE: Principal Dx-POA- N

    Posted 12-28-2018 10:21
    I code for a Long Term Acute Care Hospital - every so often a similar scenario happens and we do use POA N for the PDx.

    You are going to get an error if you code the CAD and Angina separately - as you know it is a combination code and per the POA guidelines if one component of a combination code was not POA you choose POA No.

    Codes That Contain Multiple Clinical Concepts
    Assign "N" if at least one of the clinical concepts included in the code was not present on admission (e.g., COPD with acute exacerbation and the exacerbation was not present on admission; gastric ulcer that does not start bleeding until after admission; asthma patient develops status asthmaticus after admission).
    Assign "Y" if all of the clinical concepts included in the code were present on admission (e.g., duodenal ulcer that perforates prior to admission).
    For infection codes that include the causal organism, assign "Y" if the infection (or signs of the infection) were present on admission, even though the culture results may not be known until after admission (e.g., patient is admitted with pneumonia and the provider documents Pseudomonas as the causal organism a few days later).

    Interested to hear what others are doing.

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    Kathy Completa
    Coding and Documentation Educator
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  • 5.  RE: Principal Dx-POA- N

    Posted 12-29-2018 04:56
    But I am thinking that since angina was due to thrombosis in stent Can I code it separately with POA N.

    Thanks

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    Sathya M Mohanasundaram
    Team Leader-IP DRG Coding
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  • 6.  RE: Principal Dx-POA- N

    Posted 12-29-2018 07:52
    You say that the patient was admitted for PTCA due to CAD and at the time of admission the patient did not have any anginal symptoms.  I don't know if I've seen a situation in which a patient was admitted to inpatient status to undergo a PTCA for asymptomatic CAD. Was the patient admitted to inpatient status prior to the PTCA?  Typically what I've seen for such procedures is that the patient is seen on an outpatient basis for such a scenario, and if a complication occurs, the patient is admitted to inpatient status.

    If the patient was admitted to inpatient status after the PTCA, please consider the following guidelines:

    Page 116 of the ICD-10-CM Official Guidelines for Coding and Reporting states, "Present on admission is defined as present at the time the order for inpatient admission occurs."

    Page 109 of the ICD-10-CM Official Guidelines for Coding and Reporting provides guidelines for determining the principal diagnosis on patients who are admitted from outpatient surgery.

    2019 ICD-10-CM Official Guidelines for Coding and Reporting

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    Judy Bielby
    Consultant and educator
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  • 7.  RE: Principal Dx-POA- N

    Posted 12-31-2018 05:14
    Dear Judy,

    This is the whole story of the chart. On 11/13 patient had fever and hypotension. After admission on 11/15 patient had elevated troponin where in found that NSTEMI was identified. That time angio confirmed patient has 100% occlusion at LCx. But unable to perform PTCA on that day due to BP elevation. Patient was discharged on 11/20. This is the old visit where in patient doesn't have any anginal symptoms.

    Again PTCA was planned on 12/08 in which patient is admitted for CAD without angina. On that visit only patient developed unstable angina due to thrombus in stent on 12/10. Now my question is for this scenario how the POA will be for I25.110?
    Kindly advice

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    Sathya M Mohanasundaram
    Team Leader-IP DRG Coding
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  • 8.  RE: Principal Dx-POA- N

    Posted 01-08-2019 14:49
    POA N  for your PDx would be correct for this scenario.

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    Chrystel Barron, RHIA, CCS, CCS-P, CHTS-TR, CICA
    Coding Education Instructor
    Cleveland Clinic Health System
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  • 9.  RE: Principal Dx-POA- N

    Posted 01-14-2019 09:39
    I submitted a ​question to Coding Clinic re: reporting a Principal Diagnosis with a POA of N, but did not receive a response.  As a colleague pointed out to me - we do that quite frequently with Obstetrical cases to report the complications of delivery, such as lacerations, blood loss, etc. when the patient was admitted with a "normal pregnancy".

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    Susan Roehl
    Consultant
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  • 10.  RE: Principal Dx-POA- N

    Posted 01-23-2019 04:58
    Dear Susan,
    Thanks for your effort to take it to Coding clinic.kindly get back here if you get any answer from Coding clinic
    Thanks,

    Sathya M Mohanasundaram
    Team Leader-IP DRG Coding
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    Sathya M Mohanasundaram
    Team Leader-IP DRG Coding
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  • 11.  RE: Principal Dx-POA- N

    Posted 01-24-2019 12:15
    We have 3M for coding and recently I have noticed a change in some of the POAs.  An example is COPD with acute exacerbation.  I will get a red flag with the question are both conditions present on admission.  It sure makes me stop and think when I answer.

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    Nelda Laskey RHIT
    Coder/RAC Coordinator
    Kearny County Hospital
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