Coding Scenario-Rhabdomyolysis

This elderly patient was found lying on the floor by her family members. Family states that the patient has been having frequent falls. At admission, his CPK was 1100 and his urinalysis was abnormal. Pt was diagnosed with rhabdomyolysis and UTI. Pt was treated with diuretics, hydration and antibiotics. His CPK came down to 250 by the time of discharge. What would be the principle dx?


A. 599.0, 728.88
B. 728.88, 599.0




Answer: B. Though both UTI and rhabdomyolysis qualify for principle diagnosis, (both were present on admission and both the conditions were treated in this visit) rhabdomyolysis is having more DRG value.

Coding Scenario-Cellulitis foot

Pt was admitted due to cellulitis of foot and was started on Antibiotics. Cellulitis was healing very slowly on antibiotics and additional tests revealed severe peripheral vascular disease. Patient was planned to treat with revascularization and antibiotics, but revascularization was cancelled due to patient's decision not to undergo revascuarization at this time. Patient had an excisional debridement of the wound. Cellulitis was treated with hyperbaric therapy and antibiotics. 

A. 682.7, 443.9, V64.2, 86.22, 93.59.
B. 682.6, 440.23, V64.3, 86.28, 93.59
C.682.7, 440.20, V64.2, 86.28
D.682.6, 443.9, 86.28




Answer: A.

Coding Scenarios-Small Bowel Obstruction

Scenario #1: Patient came in with abdominal pain, nausea and vomiting. CT scan of the abdomen revealed small bowel obstruction due to metastatic neuroendocrine tumor. Neuroendocrine tumor of sigmoid colon has metastasized to peritoneum, liver and ribs. Patient was treated for small bowel obstruction and was discharged to home to follow up with his primary care provider.

A. 560.9, 153.3, 197.7, 197.6, and 198.9
B. 560.9, 209.16, 209.74, 209.72, 209.73
C. 153.3, 560.9, 197.7, 197.6, and 198.9
D. 209.74, 560.9, 209.72, 209.73, and 209.16



Scenario #2: Patient came in with abdominal pain and CT scan of the abdomen revealed very dense adhesions causing the small bowel obstruction. Laproscopic lysis of adhesions was done. Postop course was uneventful and the patient was discharged home.

A. 560.9, 54.59
B. 560.81, 54.59
C. 560.81, 54.51
D. 560.9, 54.51



Answers:
Scenario #1: D
Scenario #2: C