Q: Can you define equally treated in the selection of principal diagnosis with multiple conditions?
A: When I think equally treated or when I read equally treated, it’s not an exact science. No matter how much you try to narrow it down and create a matrix and grids and everything else, it’s not an exact science. Every patient is slightly different in their conditions and how they impact the patient can vary.
You need to start to think about whether both conditions necessitate admission. That’s the first step. If they both necessitated admission, then you can check that one off the list.
Then did one of them require surgery and the other one is being treated with medication, for example? Clearly in that situation that’s not equally treated. Whatever is necessitating the surgery really should be the principal diagnosis. In the official UHDDS definition of principal diagnosis, there’s also a guideline that tells us the principal diagnosis should be related to the principal procedure. If you have a surgery for one of your conditions or a procedure for one of your conditions, then that’s going to drive you in one direction or the other.
Let’s say that neither case happened. We don’t have a surgery. Both conditions necessitate admission. Now is when you start splitting hairs. Were you using IV steroids and antibiotics to treat one condition and the patient’s normal oral medication for another condition? You didn’t up their dose. You didn’t see them switched to an IV at a higher dosage? In that situation, the condition that’s requiring IV medication or a change in their dosage is probably the one responsible for the admission.
In the world we live in now, coders need to understand more clinical information in order to define and determine principal diagnosis selection. We have to know what causes an admission. What necessitates an admission?
Physicians don’t alwayssay, “This is the condition that I admitted the patient for.” Sometimes when they say that, they don’t even understand the ramifications to the principal diagnosis selection, so that’s where you have to go back and educate the physicians too.
So really there’s a lot of layers to what is equally treated and what that means.
Editor’s note: Heather Taillon, RHIA, manager of corporate coding support services at Franciscan Alliance in Greenwood, Ind., answered this question.
This answer was provided based on limited information submitted to JustCoding. Be sure to review all documentation specific to your own individual scenario before determining appropriate code assignment.
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