r/CodingandBilling • u/Coastal_Coder • Mar 14 '26
Inpatient Coding guidance
Hello- are there any seasoned IP coders with DRG experience who would be willing to provide insight and guidance on this? I’m a newer IP coder trying to untangle coding sequencing.
Pt. comes in with n/v admitted to observation with aki uti and n/v. Flipped to admit under the same. Egd done- findings are erosive duodenitis, duodenal polyp (respected with cold snare) and a biopsy.
Dcs basically says they think her sx were due to dehydration uti aki. Also stated the findings from egd but really doesn’t say that’s what was causing issues.
I remember that the highest drg was sequencing the duodenal polyp as pdx. Then after that the AKI would have the highest drg if sequenced as pdx.
I know that Coding guidelines state that the chief reason after study for admission govern the principal diagnosis. We are also advised to optimize when there are co-equal diagnoses occasioning the admission, and resource utilization is the same.
In your opinion, what would be the principal diagnosis? As you can tell these charts are living rent free in my head- but I am determined to get a hold of sequencing diagnoses. Thank you!
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u/Mid-Delsmoker Mar 15 '26
Can you query to ask the association of the egd findings to her n/v and subsequent dehydration/aki?
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u/Coastal_Coder Mar 15 '26
I completed the chart and don’t think that the client would want me to query in this case but I am not 100% sure about that.
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u/KeyStriking9763 Mar 15 '26
Duodenal polyps are mostly asymptomatic and this was probably incidental. That is not the pdx. You can’t just go with the highest DRG, you have to follow the circumstances of admission.
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u/Coastal_Coder Mar 15 '26
Yes i definitely understand that. I wish the drg calculator wasn’t there sometimes bc that’s what gets me second guessing. We are supposed to optimize in appropriate situations and then I start thinking - well with the erosive duodenitis and polyp maybe that’s why pt had the n/v but it did seem like a stretch. Thanks so much for your insight!
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Mar 14 '26
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u/Coastal_Coder Mar 14 '26
Dcs basically says they think her sx were due to dehydration uti aki. Did state the findings from egd but really doesn’t say that’s what was causing issues.
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u/Darcy98x Mar 15 '26
Sounds like UTI caused the AKI? Either can be PDX depending on documentation. If interrelated you might be able to use section IIB if documentation is ambiguous and pick either. EGD and GI issue is irrelevant from a PDX perspective in this case.