Q&A: First listed for pulmonary exacerbation of cystic fibrosis
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 277.02 specifically denotes CF with pulmonary manifestations. To report this code, the provider must document a relationship between the pulmonary condition and the CF exacerbation. A query is necessary when the physician doesn’t document this cause-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 the CF exacerbation is the principal diagnosis. Report the specific pulmonary manifestation as a secondary diagnosis. If the treatment focuses on the pulmonary manifestation, then the pulmonary manifestation is the principal diagnosis. Report the CF as a secondary diagnosis.
Coding Clinic, 4th quarter 2002, states that coders 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, answered this question. At the time of this article's original release, she was the CDI Education Director for HCPro Inc. This article first published in the eNewsletter CDI Strategies.