Posts tagged ‘PT/INR’

June 13, 2011

Doozie of a coding case

Question: We have a doozie of a patient.
He was discharged from an inpatient stay at the hospital for abscess under the right axilla for which he had an I&D.  We are seeing him for wound care following this procedure.  The wound is clean now without any infection presently.  He also had a pulmonary embolism that was treated in the hospital with lovenox and Coumadin.  He is still on Coumadin, of course, and this affects his dressing changes as he bleeds quite a bit during the dressing changes. Plus we will be monitoring his PT/INRs of course. He also has LE DVT.

The primary reason that we are seeing him is the wound care.

He is a type 2 diabetic (fairly recently diagnosed) and just started on Levamir while in the hospital. This may delay wound healing, so I know that it needs to be pretty up in the diagnosis chain.

Past history includes CA of the appendix (which has been removed surgically), but this metastasized to the abdomen (does not give specific organ, but I am assuming colon because he has a colostomy) and the lung. He is independent with his colostomy, so I know not to code “ATTN TO” on this one. He also has hx of prostate CA as well.

His cancer is still active as he is on chemotherapy.  It is just on hold related to the fact that he had the abscess.

He is morbidly obese, has HTN (with several meds) and GERD.

I am in desperate need of assistance on this one.

Lisa says: He’s a doozie all right!! I think I would still code the wound as an abscess. Follow with the PE, DVT, diabetes, HTN, secondary site(s) of Ca. Follow with V58.83, V58,61, V44.3 and the rest of the codes. Once you’ve coded the primary, you just have to consider the seriousness of the other conditions and importance to the POC. Push your V codes to the bottom.

January 19, 2011

Followup on PT/INR … the flipside

Shortly after I posted on PT/INR, I received a question about what to do when the PT/INR fluctuates, which makes the Coumadin dosing also fluctuate. Is that enough to keep a patient admitted in home health?
Medical necessity is the key. In this case, the medically necessary service that you’re providing is observation and assessment. O and A is medically necessary when there exists a potential fluctuating condition that requires the skills of a nurse to assess and intervene.

Document well.

January 18, 2011

You cannot keep a patient for PT/INR only

Question: Is it possible to keep a patient for home health only to perform PT/INR labs. Initially we received this patient for CVA. She currently is stable but still requires therapeutic drug monitoring. Every other disease process is stable and been taught on. Is therapeutic drug monitoring a valid reason, and can it be the only reason why we continue to have the patient on board?

Lisa says: Venipuncture is a skill but not a qualifying skill for Medicare home health. A patient such as you described is usually receiving observation and assessment as the skill. Observation and assessment is considered a skill only if there is a potentially fluctuating condition. If there have been no changes, then O and A probably is no longer skilled.

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