Inpatient Facility Coding & Compliance Alert

Question: A patient was admitted with chest pain and diagnosed with congestive heart failure. She also has other conditions of lupus, hypertension and a past history of coronary artery disease, previous CABG and stent insertion. What’s our best choice for the primary diagnosis? And what DRG is best?

Illinois Subscriber

Answer: Based on the clinical scenario presented in the question, the appropriate DRG code for this scenario is 293 (Heart failure and shock without complication or comorbidity/major complication or comorbidity). Sequence the diagnosis codes as follows:

• 428.0 – Congestive heart failure, unspecified
• 414.00 – Coronary atherosclerosis of unspecified type of vessel native or graft
• 401.9 – Unspecified essential hypertension
• 710.0 – Systemic lupus erythematosus
• V45.81 – Postsurgical aortocoronary bypass status
• V45.82 – Percutaneous transluminal coronary angioplasty status.