PARTS IS PARTS
Approach for foley catheter
What is Via natural or artificial opening
Cr on 4/1/18 1.0
Cr on 4/3/18 1.4
What is AKI
Presented with CP placed in Observation
Admitted inpatient next day with altered mental status
What is the diagnosis that prompted inpatient admission- altered mental status or whatever the underlying cause for that is determined to be.
Check admit date!
Patient with pneumonia T 102.2 and HR 105.
?? Sepsis query??
What is no. The criteria for SIRS must be independent of another cause. So a HR of 104 when the patient has a fever is a normal physiologic response and does not necessarily mean sepsis. 2 hours later after the tylenol has kicked in and HR still 104, ok to query.
Glascow Coma Scale
What is COMA or AMS
–Total score 3-8: Coma
–Total score 9-12: Obtundation/stupor
–Total score 13-14: Lethargy / somnolence
Approach for lap chole
What is percutaneous endoscopic
Baseline creatinine unknown
Creatinine 4/1/18 2.7
Creatinine 4/3/18 2.4
What is not AKI
Patient presents with CVA and aspiration pneumonia.
Studies include, CXR, Head CT, Head MRI, ECHO, Neuro consult, IV antibiotics.
What is CVA
patient with colitis on CAT scan treated with IVF, IV Cipro and Flagyl- improved.
Infectious colitis?
Maybe...
Antibiotics used to treat bacterial colitis and to prophylax in setting of bowel ischemia, and used for inflammatory bowel disease. So need more information. Must query.
BMI 18
On Ensure
What is UNDERWEIGHT
MUST HAVE A DIAGNOSIS FROM MD TO CODE THE BMI AND FOR UNDERWEIGHT MUST HAVE REPORTABILITY CRITERIA
WOULD LOOK ALSO FOR NUTRITION CONSULT- COULD BE WORSE THAN UNDERWEIGHT.
Root operation where body part is cut out or off by sharp instrument without replacement
What is excision
Baseline creatinine unknown
Creatinine 4/1/18 2.7
Creatinine 4/4/18 1.8
What is AKI
Patient presents with CAP and acute CHF
Studies include ECHO, Chest X-ray, blood cultures, cardiac labs. IV lasix and IV antibiotics.
ID consulted
What is CAP
Elevated troponin after EGD
transfer patient to VMC on IV heparin, ASA, Plavix
Type II MI or ACS/NSTEMI?
Probably ACS/NSTEMI- not going to put patient routinely on high risk medication unless suspicion high.
QUERY!
Of hepatic, metabolic and toxic encephalopathy, which is not an MCC?
What is hepatic encephalopathy.
Look for GCS documentation which could be an MCC here.
Root operation for hemicolectomy
what is resection
Baseline 1.0 from 01/01/18
4/01/18 Creatinine 1.4
4/02/18 Creatinine 1.4
What is not KDIGO AKI
At this point what would creatinine have to be by day 5 to qualify for AKI query?
Patient hospitalized for hemorrhoidectomy electively, overnight developed BRBPR and admitted inpatient for ABLA.
What is whatever caused the BRBPR. It could be a complication of the procedure and that would be PDX...it could be something higher up- like diverticulosis. But it is not the hemorrhoids that were the PDX for the procedure.
Patient has sodium of 125, potassium 3.4, bicarb 23, creat 1.4 and glucose 1000.
Should we query hyponatremia?
No. This is pseudohyponatremia- sort of an "abnormal" lab reading due to the markedly elevated glucose.
This can also be caused by markedly elevated triglycerides or protein.
Brandy got me on this one...
This makes GCS an MCC
| Eye opening | Spontaneously | 4 | |
| Verbal Command | 3 | ||
| To pain | 2 | MCC | |
| None | 1 | MCC | |
| Verbal | Oriented | 5 | |
| Confused but answers questions | 4 | ||
| Inappropriate, words discernible | 3 | ||
| Incomprehensible speech | 2 | MCC | |
| None | 1 | MCC | |
| Motor | Obeys commands | 6 | |
| Purposeful movement to pain | 5 | ||
| Withdraws (reflexive) from pain | 4 | ||
| Abnormal (spastic) flexion | 3 | ||
| Extensor (rigid) response | 2 | MCC | |
| None | 1 | MCC |
Root operation of BKA
Detachment
Baseline creatinine 1.0 01/01/18
4/1 CR 3.4 Anuric
4/2 CR 3.6 oliguric
4/3 CR 3.7
4/4 CR 2.2
Yes, there are criteria for AKI
AND
What??? else might you query for?
Patient admitted with pneumonia and sepsis and AKI. After 7 days of IV antibiotics check procalcitonin and negative. MD says no pneumonia or sepsis.
AKI
Even though this patient was treated for pneumonia and sepsis the diagnosis was excluded, cannot code.
Patient has lap chole. Pre procedure HGB 14. Two days later HGB 9. OP note says EBL 50 cc.
Query acute blood loss anemia?
No. MD said only lost 50 cc blood during surgery. Can query precipitous drop in HGB.
sepsis, pneumonia with AKI
Can we code severe sepsis?
No. Must connect the AKI to the sepsis, must query to determine cause of the AKI.