Transcript ALC, Pneumonia, COPD, Strokes

ALC, Pneumonia,
COPD, Strokes
HS317b – Coding &
Classification of Health Data
Alternate level of care
Mandatory to record ALC via service
transfer area in DAD in all provinces
 Designed to separate statistics for true
acute care patients from those non-acute
patients occupying acute care beds
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 Has
the patient finished the acute care phase
of his/her treatment but remains in the acute
care bed
 Awaiting
placement (extended care facility, hospice,
residential care home, community services, etc)
 No respite care available.
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ALC days removed from DAD before national
length of stay norms are established.
Standardize data collection
Diagnosis type W
Diagnosis
Z50.1 Other physical therapy
 Z51.5 Palliative care
 Z54.~ Convalescence
 Z59.~ Problems related to housing and
economic circumstances
 Z60.2 Living alone
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Diagnosis
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Z74.2
Need for assistance at home and no
other household member able to render care
Z75.~
Problems related to medical facilities
and other health care
Z76.1
Health supervision and care of
foundling
Z76.2
Health supervision and care of other
healthy infant and child
COPD Folio lookup
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Obstruction, obstructed, obstructive
– airway J98.8
– – chronic J44.9
– – with
– – – allergic alveolitis J67.9
– – – asthma NEC J45.9
– – – bronchiectasis J47
– – – bronchitis (chronic) J44.8
– – – emphysema J43.9
Chronic Obstructive Pulmonary Diseases
(COPD)
 A group of common chronic respiratory
disorders (progressive, degenerative,
obstructive)
 Chronic
asthmatic bronchitis
 Chronic emphysematous bronchitis
 Chronic bronchitis with emphysema
 Chronic bronchitis with airway obstruction
 Chronic obstructive asthma
 Chronic obstructive bronchitis
 Chronic obstructive tracheobronchitis
Coding COPD J44.~
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If asthma (J45.~), chronic bronchitis
(J42.~) , or emphysema (J43.~) are
specified as chronic, obstructive go to
J44.~
 Note
exclusion notes under each condition
which direct you to J44.~
A patient with COPD presents with a
shortness of breath. Chest X-ray revealed
evidence of chronic disease of the lungs.
He was admitted for treatment of COPD
exacerbation.
Exacerbation of COPD
Is an acute clinical deterioration in a
patient’s respiratory status due to a
worsening of underlying COPD
 Apply coding rule for acute & chronic in a
condition/disease
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J44.1 Chronic obstructive pulmonary
disease with acute exacerbation,
unspecified
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A patient with COPD presents with a lower
respiratory tract infection. Chest X-ray
revealed pneumonia. He was admitted for
treatment of COPD exacerbation and
pneumonia
COPD with acute respiratory infection
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Coding rules:
 Respiratory
tract infections or irritants may
trigger an exacerbation
 COPD patients high risk for pneumonia.
 Use J44.0 Chronic obstructive pulmonary
disease with acute lower respiratory infection
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Consider it a ‘combination category’
Combination categories
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J44.0 Chronic obstructive pulmonary disease
with acute lower respiratory infection
J18.9 Pneumonia, unspecified
Create international comparability
ICD-10-CA has combination code for COPD &
pneumonia
No implied relationship
It may have an impact on LOS & treatment.
Infection & COPD
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With acute lower respiratory tract infection
 Code
J44.0 Chronic obstructive pulmonary disease
with acute lower respiratory infection
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Additional code is not required to reflect the
infective component unless it is specified
i.e. pneumonia or acute bronchitis
 A condition
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in its own right
Assigned a diagnosis type 1
Pneumonia
Hospital Acquired (nosocomial)
 Community Acquired infection
 Patient with immunosuppressive disease
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No further info describing pneumonia
 Assign
J18.9 Pneumonia, unspecified
Infection & Pneumonia
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Pneumonia…
- - Escherichia coli (E. coli) J15.5
– – Friedländer's bacillus J15.0
– – Haemophilus influenzae J14
J15.5 Pneumonia due to Escherichia coli
Rules for coding pneumonia
 If
organism is identified by physician follow
lookup for appropriate code
 Do not use sputum cultures on lab reports
 Goes back to rule of ‘Using Diagnostic Test
Results in Coding
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Microbiology report positive for micro-organism
growth but no documentation in physician’s notes
identifying diagnosis or treatment…It is
inappropriate application of diagnostic tests
Pneumonia & HIV
HIV disease classified to chapter 1
 B24 Human immunodeficiency virus [HIV]
disease
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 Use
additional code(s) to identify all
manifestations of HIV disease
B24 must be designated as MRDx
 Manifestation sequenced immediately
following B24
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Patient with AIDS came in with PCP
pneumonia
B24 (M) Human Immunodeficiency virus
B59 (1) Pneumocystosis
J17.3 (3) pneumonia in parasitic disease
HIV cases are grouped according to the
diagnosis that is placed in the second
position on the abstract. If other
manifestations are present but not treated
during current episode of care, may be
assigned diagnosis type 3.
Respiratory failure
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Classified as either acute or chronic
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J96.~ or J96.1 or J96.9
When the respiratory failure occurs during
an episode of care either before any
surgical intervention has taken place or
after 15 days following any surgical
intervention
 Use
J95.88 (postprocedural) + J96.~ (3)
Patient with osteoarthritis of the hip came
into hospital for a hip replacement.
Surgery was done and two days
postoperative patient developed
respiratory failure.
Postprocedural respiratory failure
J95.88 (2) Other postprocedural
respiratory disorder
 J96.0 (3) Acute respiratory failure
 Y83.~ (9) Surgical procedure…
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All postprocedural rules apply
Respiratory failure & ARDS
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Acute respiratory distress syndrome (J80)
 A syndrome
of severe respiratory failure
associated with pulmonary infiltrates.
 A # of clinical conditions associated – Sepsis and
systemic inflammatory response syndrome.
 Trauma (head injury, pulmonary contusions are
strongly associated with development of ARDS
 J96.~ is inherent with this syndrome and it is not
necessary to code
Desaturations
Decreased levels of oxygen in the blood.
 No specific Folio lookup…
 Look for cause.
 No lookup use R09.0
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 Deficiency
– oxygen R09.0
Mechanical Ventilation
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Mechanical Ventilation and continuous positive
airway pressure (CPAP)
 Methods
of supporting intubated patients during
illness.
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1.GZ.31.~ ~ captures all types of ventilation
Extent attribute is mandatory for code
1.GZ.31.CA-ND using positive pressure
mechanical ventilator