MRA Thought of the Day–Difficult Coding Scenario: Searching for an unlikely CC
An 88 year old patient was admitted to the hospital after suffering a cerebral infarct. After review of the record, code 434.91 was assigned as the Principal Diagnosis along with several other chronic condition codes resulting in a DRG of 066 – Intracranial Hemorrhage or Cerebral Infarction without CC/MCC. No complication or comorbidity (CC/MCC) condition was identified. Or was a valid condition missed by the coder?
Here are my thoughts…
- Re-review the chart carefully to make sure a CC or MCC has not been missed.
- Read the Neurology consult Left-sided neglect is a neuropsychological condition in which damage to one hemisphere of the brain results in the patient’s inability to process and perceive stimuli on the left side of the body. The patient acts as if their left side of sensory space is non-existent. This may cause patients to easily fall, collide with objects on their left side such as door frames or neglect to eat the food on the left side of their plates.
- Code those manifestions and review the ICD-9-CM alphabetic index. There is a code for left-sided neglect (781.8) which happens to be a CC, placing the case into the higher weighted DRG of 065 – Intracranial Hemorrhage Infarction with CC.
Conduct a thorough review of the chart to ensure you have captured all pertinent diagnoses that meet secondary diagnosis criteria per Coding Clinic (4Q 2008, p. 305-306) and to ensure optimum reimbursement for your hospital. And be diligent in researching unfamiliar terms because an uncommon phrase may just be the CC you were looking for.
What are your thoughts?