![]() ![]() The last facet of documenting the emergency department cardiac arrest is to be sure to take inventory of the resultant conditions. I think a cardiac arrest is clinically relevant and should be coded. This is not a diagnosis that “relates to an earlier episode and has no bearing on the current hospital stay,” which would exclude it per Uniform Hospital Discharge Data Set (UHDDS) rules. My conclusion is that even if the patient is resuscitated pre-hospital, the workup and treatment continue in the emergency department and intensive care unit. If the cause is not determined, the I46.9 code could serve as principal diagnosis. ![]() I46.2 and I46.8 would be secondary diagnoses because if you establish the underlying cause, that defines the principal diagnosis. The options are I46.2, Cardiac arrest due to an underlying cardiac condition, I46.8, Cardiac arrest due to other underlying condition, and I46.9, Cardiac arrest, cause unspecified. The cardiac arrest codes are found in I46. The fact that the patient died in the hospital is embedded in their discharge status and there is an alternate mechanism to report inpatient deaths. If the patient dies in-house from the cardiac arrest without attempt at resuscitation, such that the cardiac arrest is their terminal event, you do not code the arrest. If the patient dies during the admission, the cardiac arrest will not serve as a major complication or comorbidity (MCC). If a patient sustains cardiac arrest in the hospital and you attempt (or are successful at) resuscitation, you code it and the procedures performed. For that, I and Coding Clinic have a definitive answer. This intellectual exercise reminded me of debates I had previously about whether you code cardiac arrest in the hospital if the patient is not successfully resuscitated. I found guidelines regarding cardiac arrest in Coding Clinic from February 1988, updated in the ICD-10-CM and -PCS Coding Handbook, but these were all regarding patients who were still in arrest at the time of arrival to the ED. I checked the ICD-10-CM Official Guidelines for Coding and Reporting for FY 2019. Perhaps Z03.89, Encounter for observation for other suspected diseases and conditions ruled out? Potentially you could use Z86.74, Personal history of sudden cardiac death, to add the element to the story, but if the patient is one of the lucky few who has complete recovery, this is not an acceptable principal diagnosis, and it really should be reserved for the subsequent encounter. However, I think leaving out the cardiac arrest would be leaving out a key part of the story. For instance, if the patient has anoxic brain damage and is in respiratory arrest and on a ventilator, those could be the captured diagnoses. If there are residual issues or deficits, those could be definitive diagnoses. If a patient has a symptom that elicits a work up, but it has resolved by the time they are brought into the ED, you still can code it, such as with syncope or altered mental status. On the other hand, you are doing the workup because it occurred. We have enough trouble getting confirmation and coding of diagnoses that resolve in the ED, in scenarios in which you might hear, “I don’t know if the patient had respiratory failure in the ED before they hit the floor. On the one hand, the condition is no longer present. I asked around and was surprised that I was not alone in being unsure whether you code the cardiac arrest if it had resolved by presentation. The first scenario I considered was how to code a cardiac arrest with successful resuscitation or return to spontaneous circulation (ROSC), prehospital. Cardiac arrest was the first one that came to mind. In March, I am doing a webinar on clinical documentation improvement (CDI) in the emergency department (ED), and I felt there were certain conditions or situations encountered in the ED that needed specific mention and attention. The incidence in any given hospital on any given shift is somewhere between zero and what you see on TV medical shows. ![]() There are approximately 350,000-400,000 cases of cardiac arrest arising outside of the hospital setting per year, and not all of these patients make it to the emergency department. ![]() Coders need to know when and how the cardiac arrest occurred. ![]()
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |