Question

A 76-year-old morbidly obese white male, was admitted to the facility with an acute exacerbation of COPD. He is a previous smoker, but has not smoked for the past year because his breathing issues have continued to worsen. He was started on oxygen and treated with an oral corticosteroid with prophylactic antibiotics administered. The progress note of day two states that the pressure ulcer of his right heel (stage 4) was non-excisionally debrided at the bedside.

As an auditor, you review the POA status, code assignment, and DRG assignment shown below for this patient’s stay. You conclude there is an error.

You will need to do the following:

What is the error, and what impact does it have on reimbursement?

What action might need to be taken to justify your conclusion of the coding error?

Answer 1

What is the error, and what impact does it have on reimbursement?

The patient should not be coded for two different diagnoses of COPD, and non-excisional debridement. Non-excisional debridement is the non-operative brushing, irrigation, scrubbing of tissue and necrosis. It is done at the bedside. It differs from excisional debridement where the surgical removal of necrosis tissue is done. Non-excisional debridement should not be included in the DRG payment. It affects the reimbursement of the patient. The auditor should properly be documented with all reports.

What action might need to be taken to justify your conclusion of the coding error?

Coding should be used as per the guideline. If the patient has a clinical presentation of more than one condition, then the principal diagnosis has to be coded properly. The patient's one condition should not assign over another. The coder should decide well which should be assigned as the principal diagnosis. Here, the patient is admitted for COPD and receiving corticosteroids, oxygen, and IV antibiotics. In addition, the patient had heel ulcer which requires dressing at the bedside. Although he requires care for heel ulcer, the inpatient admission is for COPD. So the principal diagnosis is controversial. Once the diagnosis is coded, the additional complaint should not be added which becomes error and creates the problem in the claim. Thus the coder should have proper knowledge of including all the symptoms in a single code.