AHA Coding Clinic- 1Q, Vol25, Num1, Pg10-11
Question:
A patient was seen in the emergency department with a two-day history of abdominal pain, nausea and vomiting due to acute gastroenteritis. The patient has hypertension and chronic renal insuffi-ciency, status post renal transplant and is unable to tolerate anything by mouth, including his medi-cation. He was admitted to the hospital for treatment of dehydration with aggressive hydration. What is the principal diagnosis, acute gastroenteritis or dehydration? What is the sequencing if the same patient's gastroenteritis is evaluated with stool studies and/or treated with oral antibiotics along with hydration?
Answer:
Assign code 276.51, Dehydration, as principal diagnosis. Assign codes 558.9, Other and unspecified noninfectious gastroenteritis and colitis, 403.90, Hypertensive chronic kidney disease, Unspecified, With chronic kidney disease stage I through stage IV, or unspecified, 585.9, Chronic kidney disease, Unspecified, and V42.0, Organ or tissue replaced by transplant, Kidney, as additional diagnoses.
The patient was admitted for treatment of dehydration. The circumstances of inpatient admission always govern the selection of principal diagnosis; the condition established after study to be chiefly responsible for occasioning the admission of the patient to the hospital for care.
If the gastroenteritis was evaluated via stool studies etc., the dehydration would still be the principal diagnosis since this was the reason for the admission. These diagnostic studies would only affect selection of the secondary diagnosis (e.g. infectious gastroenteritis).
****This through me for a loop.... I would have coded the Gastroenteritis then the dehydration because the gastroenteritis caused the dehydration....
