First I am sorry that i dont know inpatient guidelines IP- DRG..
But according to iCD 10 Fluid overload can not be coded if CHF exacerbation is there BecauseI50.9 excludes 1 it states fluid overload is there.
Also if the patient is presenting for a condition the intergral part that is signs and symptoms can not be coded together...
So Fluid overload can not be coded if we are coding CHF exacerbation.
Also the patient had dialysis during the hospital stay.. But he/she is not treated for that dialysis.
Accorrding to the research which i am attatching the article url dialysis patients can develop CHF.
http://www.ncbi.nlm.nih.gov/pubmed/7752588
In this case CHF exacerbation is the PDX because it is the worsening state. Even though the dialysis patient undegoing we dont know which stage the patient is in.
If we dont treat dialysis the patient might goes to next level.. But if we dont treat exacerbation conditions it might lead to death.
Exacerbated CHF is an emergency condition and should receive immediate treatment from health professionals
So the priority goes to CHF exacerbation because it is in the worsening state.
Please correct me if i am wrong as i am not a inpatient coder.