Q&A: Clarifying pulmonary exacerbation of cystic fibrosis
November 21, 2012
CDI Strategies - Volume 6, Issue 24
Q: Should we query for the specific pulmonary exacerbation of cystic fibrosis (CF)? Coding Clinic states that the exacerbation of CF should be listed first.
A: ICD-9-CM codes for CF (i.e., 277.00-277.03) are combination codes. ICD-9-CM code 277.02specifically denotes CF with pulmonary manifestations. To report this code, the provider must document a relationship between the pulmonarycondition and the CF exacerbation. A query is necessary when the physician doesn’t document thiscause-and-effect relationship linking the two diagnoses.
The nature of the admission determines the principal diagnosis. If the treatment focuses on the exacerbation of the CF, then theCF exacerbation is the principal diagnosis. Report the specific pulmonary manifestation as a secondary diagnosis. If the treatment focuses on the pulmonary manifestation, then thepulmonary manifestation is the principal diagnosis. Report the CF as a secondary diagnosis.
Coding Clinic, 4th quarter 2002, states that coders/CDI specialists must query the physician to identify the relationship of the manifestation/complication to the CF. The circumstances of the admission dictate the principal diagnosis and sequencing.
Editor’s Note: Cheryl Ericson, MS, RN, CCDS, CDIP, education director at HCPro, Inc. and an AHIMA-approved ICD-10-CM/PCS trainer in Danvers, MA, answered this question. For information about CDI-related Boot Camps taught by Ericson, visit www.hcprobootcamps.com.
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