Coding, Classification and Reimbursement

Anemia due to AVM

  • 1.  Anemia due to AVM

    Posted 11-21-2018 15:15

    Pt was admitted for anemia likely due to GI bleed from gastric AVM.  All treatment was centered around treating the anemia and N=no treatment was done for the AVM.  What should be sequenced as pdx? Anemia or AVM?

    On another case a non-bleeding AVM was found on an EGD. EDG states coagulation for hemostasis- clip placed.  What is the right root operation? I'm having a hard time determining the procedure code.  It is not control as the AVM was non bleeding.  Occlusion would put this into an unrelated pdx/px DRG.  Restriction? Repair?

    Any advice is much appreciated!

  • 2.  RE: Anemia due to AVM

    Posted 11-22-2018 09:50
    I had sent Coding Clinic a question about the sequencing of Anemia/GIB and they responded "The circumstances of inpatient admission always govern the selection of PDX". They also sited the UHDDS definition of PDX and stated if the coder is unclear as to which condition meets this definition, the provider should be queried for clarification. Finally, they stated the Guideline for when 2 or more diagnoses equally meet the criteria for PDX as determined by the circumstances of the admission, diagnostic workup and/or therapy provided, any one of the diagnoses may be sequenced first.

    For the procedure, I would still go with "Control" per advice in Coding Clinic 4Q 2017 pg 105 for the question "Is 'Control' of bleeding appropriate for this procedure when there is no documentation of active bleeding?" and the response was "When a patient is seen for bleeding and a procedure is performed to control the hemorrhage and prevent a recurrent bleed, assign a code for control of bleeding. Active bleeding does not need to be demonstrated during the encounter to diagnose and treat an active hemorrhage"

    Karen Neal
    Coding Quality Auditor
    Conifer Health Solutions