eur Coding Guidelines Review Exercises: Chapter 3 (Continued) Re For exercises 7
ID: 138264 • Letter: E
Question
eur Coding Guidelines Review Exercises: Chapter 3 (Continued) Re For exercises 7-16: Principal Diagnosis for Inpatient Care following scenarios. . Apply the CO 10CM Official Guidelines for Coding and Reporting of the (Guidelines Il A-J) to identity the principal diagnosis in the Patient was admitted to the hospital after was to rule out epilepsy. After testing was performed, the cause of the seizure was not determined, as the physician stated the patient did not have epilepsy. having a seizure at work. The admitting diagnosi 7. Patient was admitted to the hospital with acute pyelonephritis and acute cystts. Both infections were evaluated and treated with intravenous antibiotic therapy. The patient was discharged home to continue taking oral medications. Patient was admitted to the hospital with acute exacerbation of chronic obstructive pulmonary disease and acute low back pain. Both conditions were evaluated, and the patient received medical treatment. The patient was discharged home to continue to receive physical therapy for the back pain and pulmonary rehabilitation therapy for his chronic lung disease 9. 10. The patient was admitted to the hospital with a multitude of gastrointestinal symptoms After diagnostic tests were performed, the physician was unable to determine exactly what was causing the patient's symptoms. The physician's final diagnosis was acute pancreatitis versus acute cholangitis. The patient was admitted to the hospital with left lower quadrant abdominal pain. After study, the physician concluded the patient's abdominal pain could have been due to either of two conditions. Her final diagnosis was abdominal pain due to either a ruptured ovarian cyst or acute salpingitis. 11. The patient was admitted to the hospital for a total right knee replacement for osteoarthritis of the knee. During the patient's preoperative preparation, the patient began having chest pain. The patient's knee surgery was cancelled, and the patient had extensive testing to determine the source of the chest pain, which was determined to be due to hypertensive heart disease. 12. The patient was readmitted to the hospital for a postoperative wound infection. The patient had been discharged from the hospital five days ago, after having colon surgery for rup- tured diverticulitis. During this hospital stay, the patient was treated for the wound infection and monitored for the remaining diverticulitis in his colon. 13. The patient was admitted to the hospital with fever, cough, and shortness of breath. After study, the physician could not identify the exact cause of these symptoms but felt the most likely cause was pneumonia. The physician's final diagnosis was "possible viral now resolving. 14. ia (Continued on next page) 10Explanation / Answer
7 .Principal diagnosis is seizure.
8it could be either acute pyelonephritis or acute cystitis as both were treated during the hospital stay.
9 Principal diagnosis could be either COPD with acute exacerbration.1or acute low back pain as two diagnosis equally meet the definition of principal diagnosis.
10Principal diagnosis could be either acute pancreatitis or acute cholangitis as both are unconfirmed diagnosis and could explain the patients symptoms.Because there are no specific symptoms noted ,either the former or latter maybe listed as the principal diagnosis.
11Principal diagnosis is left lower quadrant abdominal pain .The diagnosis of ruptured ovarian cyst and acute salpingitis are coded as additional diagnosis.
12 Principal diagnosis is osteoarthritis of knee.Additional codes for hypertensive heart disease and code for surgical or other procedure not carried out because of contraindication ,would be assigned.
13Principal diagnosis is postoperative wound infection .An additional diagnosis for diverticulitis is assigned.
14 Principal diagnosis is viral pneumonia.
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