ALC, Pneumonia, COPD, Strokes

1
ALC, Pneumonia, COPD, Strokes

• HS317b Coding Classification of Health Data

2
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
• Has the patient finished the acute care phase of
  his/her treatment but remains in the acute care
  bed

3

• Awaiting placement (extended care facility,
  hospice, residential care home, community
  services, etc)
• No respite care available.
• ALC days removed from DAD before national length
  of stay norms are established.
• Standardize data collection
• Diagnosis type W

4
Diagnosis

• Z50.1 Other physical therapy
• Z51.5 Palliative care
• Z54. Convalescence
• Z59. Problems related to housing and economic
  circumstances
• Z60.2 Living alone

5
Diagnosis

• 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

6
COPD Folio lookup

• 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

7

• 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

8
Coding COPD J44.

• 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.

9

• 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.

10
Exacerbation of COPD

• Is an acute clinical deterioration in a patients
  respiratory status due to a worsening of
  underlying COPD
• Apply coding rule for acute chronic in a
  condition/disease
• J44.1 Chronic obstructive pulmonary disease
  with acute exacerbation, unspecified

11

• 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

12
COPD with acute respiratory infection

• 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
• Consider it a combination category

13
Combination categories

• 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.

14
Infection COPD

• With acute lower respiratory tract infection
• Code J44.0 Chronic obstructive pulmonary disease
  with acute lower respiratory infection
• Additional code is not required to reflect the
  infective component unless it is specified
• i.e. pneumonia or acute bronchitis
• A condition in its own right
• Assigned a diagnosis type 1

15
Pneumonia

• Hospital Acquired (nosocomial)
• Community Acquired infection
• Patient with immunosuppressive disease
• No further info describing pneumonia
• Assign J18.9 Pneumonia, unspecified

16
Infection Pneumonia

• Pneumonia
• - - Escherichia coli (E. coli) J15.5
• Friedländer's bacillus J15.0
• Haemophilus influenzae J14
• J15.5 Pneumonia due to Escherichia coli

17
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
• Microbiology report positive for micro-organism
  growth but no documentation in physicians notes
  identifying diagnosis or treatmentIt is
  inappropriate application of diagnostic tests

18
Pneumonia HIV

• HIV disease classified to chapter 1
• B24 Human immunodeficiency virus HIV disease
• Use additional code(s) to identify all
  manifestations of HIV disease
• B24 must be designated as MRDx
• Manifestation sequenced immediately following B24

19

• Patient with AIDS came in with PCP pneumonia
• B24 (M) Human Immunodeficiency virus
• B59 (1) Pneumocystosis
• J17.3 (3) pneumonia in parasitic disease

20

• 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.

21
Respiratory failure

• Classified as either acute or chronic
• Use 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)

22

• Patient with osteoarthritis of the hip came into
  hospital for a hip replacement. Surgery was done
  and two days postoperative patient developed
  respiratory failure.

23
Postprocedural respiratory failure

• J95.88 (2) Other postprocedural respiratory
  disorder
• J96.0 (3) Acute respiratory failure
• Y83. (9) Surgical procedure
• All postprocedural rules apply

24
Respiratory failure ARDS

• 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

25
Desaturations

• Decreased levels of oxygen in the blood.
• No specific Folio lookup
• Look for cause.
• No lookup use R09.0
• Deficiency oxygen R09.0

26
Mechanical Ventilation

• Mechanical Ventilation and continuous positive
  airway pressure (CPAP)
• Methods of supporting intubated patients during
  illness.
• 1.GZ.31. captures all types of ventilation
• Extent attribute is mandatory for code
  1.GZ.31.CA-ND using positive pressure mechanical
  ventilator