# Help with ICD 9 dxs



## olgunchik (Aug 8, 2008)

Hi guys,
I need help with two scenarios to determine dxs. Any help would be greatly appreciated. Also, if you can explain how you came up with this codes, it would be wonderful help. Thanks a lot.

1. A patient has chronic renal failure and is regularly dialysized.  The patient is noncompliant with dialysis and diet and goes into volume overload due to salt and fluid levels.  As a result of the volume overload, the patient develops congestive heart failure and acute renal failure.  The physician specifically states that the CHF is due to poor compliance of salt and water restrictions rather than from a primary cardiac dysfunction.  

My guess would be: 428.0, V15.81, 584.9

2. Patient presents for continued care of his arteriosclerosis involving two native  coronary arteries and one bypassed artery using a saphenous vein graft.  

Here I don't even now where to start


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## lavanyamohan (Aug 8, 2008)

olgunchik said:


> Hi guys,
> I need help with two scenarios to determine dxs. Any help would be greatly appreciated. Also, if you can explain how you came up with this codes, it would be wonderful help. Thanks a lot.
> 
> 1. A patient has chronic renal failure and is regularly dialysized.  The patient is noncompliant with dialysis and diet and goes into volume overload due to salt and fluid levels.  As a result of the volume overload, the patient develops congestive heart failure and acute renal failure.  The physician specifically states that the CHF is due to poor compliance of salt and water restrictions rather than from a primary cardiac dysfunction.
> ...



Reply:
1. You have to code volume overload first, followed by congestive heart    
    failure.
    276.6; 428.0
2. Give the by-passed artery code first, followed by the native arteries codes.


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## olgunchik (Aug 9, 2008)

Thank you so much for your help. However, I have a couple of questions, because I try to understand path ways to coding. 
What about acute renal failure? Also, salt levels?  I understand, we are covered fluid levels. And second scenario.... it is a mistery for me. How did you came up with these codes? What were your thoughts? Please share!!!! 
Sorry for asking these questions.


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## cmartin (Sep 3, 2008)

For the 2nd scenario, I would think 414.01 and 414.02 [Coronary atherosclerosis; of native coronary artery and of autologous vein bypass graft].  Start with the index under Arteriosclerosis, coronary (artery).


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