#Principle crack full
#Principle crack code

Follow up therapy for both diagnoses will be ongoing on an outpatient basis.Ī patient comes in with complaints of SOB and chest pain. My rationale is that the CHF consumed most of the resources provided and the A fib resolved without return with one dose of metoprolol.

#Principle crack code

The patient does not return to A fib, paroxysmal and is discharged two days later on a cardiac diet, Coreg 3.375mg oral (PO) BID, 20mg Lasix PO on prescription with a follow-up appointment for the cardiologist in two weeks for a planned electrophysiology study to be performed to reevaluate the A fib.įor this scenario, I would code the principal diagnosis as the combination code for hypertensive heart disease and code the acute diastolic CHF as the MCC and then code the A fib as a secondary diagnosis (regardless of relative weights).

The patient is weaned to room air with resolution of SOB. IV Lasix of 40mg x 1 (additional dose) is given with a repeat chest x-ray showing an improvement in vascular congestion and no pulmonary edema was identified on repeat film. A fib RVR and acute diastolic CHF, new onset are diagnosed.

ECHO ordered and shows ejection fraction (EF) 55%, mitral regurgitation (MR) +2, left ventricular hypertrophy (LVH).

The patient continues on 2L oxygen with lowest saturation of 93%. The patient is receiving continuous telemetry.

The patient diuresed 1L UOP, HR has converted to sinus rhythm with a rate in the low- to mid-90s.

The patient is admitted for acute onset CHF and A fib RVR. Foley is inserted and 40mg IV Lasix is given.

Treatment: 2L oxygen via nasal cannula is applied with saturation at 96%.

Labs: Brain natriuretic peptide (BNP) is drawn and results at 1200.

Chest x-ray: Cardiomegaly, vascular congestion and bilateral atelectasis.

Physical Exam: Audible wheezing with rales in the left lower lobe.

Patient reports no history of congestive heart failure (CHF).

#Principle crack full

Dyspnea noted on exertion and patient can speak in full sentences at this time. The emergency department physician documents the following: Patient presents with worsening SOB over two days.

Chest x-ray reveals cardiomegaly and vascular congestion with atelectasis.EKG reveals A fib with rapid ventricular response (RVR) with a rate of 153.The patient has a past medical history of atrial fibrillation (A fib) on coumadin, hypertension (HTN), and diabetes mellitus (DM). A hospitalist is the attending on this case. I have created two patient scenarios (they are made up case examples and do not reflect actual cases) for you to compare, although I don't think you will need them.Ī patient comes in with complaints of shortness of breath (SOB). I would be weighing the resource consumption on the two diagnoses and make my determination accordingly. I always go by the old motto of 'doing the right thing for the right reasons' because good only follows that premise.Īs a former auditor, I would be denying all the cases I saw where the ONLY determining factor for principal diagnosis selection was relative weight. Everyone must go with the culture of their employer but speaking of CDI as an industry, it is unwise in my opinion for a CDI department to be driven by financial impact when determining which diagnoses should be principal in the scenario you outlined. Q: When a patient comes in with two diagnoses and the documentation reflects that either could be the principal diagnosis, do we choose the principal as the diagnosis that is being treated more intensely, or do we choose the higher paying DRG? Is it true that when a patient comes in with two diagnoses with both being treated equally, you can choose either as the principal diagnosis? In a case where one diagnosis is being treated more intensely, however, do you choose that one even though it is a lower weighted DRG? I usually choose the one that is being treated more intensely even though it might be lower weighted.Ī: I am in 100% agreement with you.