Health Information Management

Ask the expert: Assigning a principal diagnosis code for patient with cholelithiasis and gallstone pancreatitis

HIM-HIPAA Insider, August 5, 2008

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Q: A physician diagnoses a patient with cholelithiasis with gallstone pancreatitis. Coding Clinic states that the primary diagnosis depends on the circumstances of admission. I wanted to find out which diagnosis we should report as primary. Technically, the cholelithiasis and gallstone pancreatitis are both present on admission (POA). But I’ve always felt that when a physician performs a cholecystectomy, it is the definitive treatment and warrants reporting the gallstone diagnosis first.
 
I know that sometimes physicians wait for the pancreas to “cool down,” but if they end up performing a cholecystectomy, shouldn’t we report the gallstone diagnosis first? I’ve thought that if they don’t perform the cholecystectomy and only treat the pancreatitis or symptoms of it, then we should code the pancreatitis first.
 
Coding Clinic answered a question about which diagnosis should be coded first when a patient is admitted for an elective cholecystectomy due to gallstone pancreatitis. It states that the pancreatitis should be coded first, but I fail to see how that is possible. If a patient has pancreatitis still flaring, chances are he or she will be admitted as an inpatient rather than have an elective procedure. If the surgery is elective and the physician treats the gallstones—since a cholecystectomy doesn’t treat pancreatitis—then why shouldn’t we code the gallstones first?
 
A: Per Coding Clinic, second quarter, 1996, pp. 13–15 (particularly the last paragraph of the last question and answer):
The correct coding and sequencing of gallstone pancreatitis depends on the location of the gallstone and reason for treatment. Assign the appropriate code from category 574, Cholelithiasis. Review the record and query the physician regarding the pancreatitis. Assign code 577.0 for acute pancreatitis or 577.1 for chronic pancreatitis.
In your particular case, if the patient presents for an elective cholecystectomy for gallstone pancreatitis, assign the appropriate code from category 574 as the principal diagnosis. Query the physician if there are any signs, symptoms, or laboratory evidence of pancreatitis. Again, sequencing depends on the circumstances of the admission.
 
Editor’s note: Sandy Sillman, RHIT, PAHM, DRG coordinator for Henry Ford Health System in Detroit, answered this question. This Q&A was excerpted from the July issue of Briefings on Coding Compliance Strategies. For more information, visit www.hcpro.com/content/213844.cfm.
 



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