Q&A: Reporting medically-induced coma

Q: I have a question about coding a medically-induced coma, for example, a patient on a Precedex drip for alcohol withdrawal, supported with mechanical ventilation, and intensive nursing care.

A: I would recommend against reporting a diagnosis where the condition is the intended consequence of medical therapy. Certainly the alcohol withdrawal and detox are reportable. If the patient’s withdrawal is severe enough to require sedation and ventilation, then alcoholic delirium tremens (DTs) may be reportable, if appropriate.

While medically induced/iatrogenic complications may be reported when they are unintended consequences, the rules are different when the condition is essentially a therapeutic state. Coding Clinic has not specifically addressed this scenario, though they have addressed similar scenarios where the condition was intentionally precipitated.

Coding Clinic, Second Quarter 2009, p. 14, addresses a scenario where ventricular fibrillation was purposefully induced. It advised against reporting a condition that was intentionally precipitated, unless that condition is one the patient would naturally have, such as a stimulated seizure in patients with established seizure disorders and known issues with a stimulated ventricular tachycardia.

Since this patient would not ordinarily be in a coma, it is most likely not reportable, even with the Glasgow scoring scale. 

Editor’s note: Allen Frady, RN, BSN, CCDS, CCS, CDI education specialist for BLR Healthcare in Middleton, Massachusetts, answered this question. Contact him at AFrady@hcpro.com. For information regarding CDI Boot Camps visit http://hcmarketplace.com/clinical-doc-improvement-boot-camp-1.