Resources Categorized As: CDI+ Newsletter

Acute on Chronic Respiratory Failure

Case: A 67 year old female with severe COPD and chronic respiratory failure on home oxygen at 2 L/min (28%) is admitted with symptoms of wheezing, cough, chest congestion and increased shortness of breath. She had increased her home oxygen to 4 L/min (36%) with some...

Admission for UTI and Altered Mental Status

Case:  An otherwise healthy, 85 year old was admitted with fever and altered mental status, no vomiting. Urinalysis showed WBC, RBC and positive nitrite; urine culture ordered (no blood cultures).  IV Cipro and IVF at 100 cc/hr started with clear liquid...

Clinical Validation – Where do we Stand?

As everyone probably knows by now that the 2017 Official Guidelines for Coding and Reporting, effective October 1, 2016, contains a new, perplexing and problematic section I.A.19 titled “Code assignment and Clinical Criteria” regarding clinical diagnostic criteria...

CMS Responds to New Sepsis-3 Definition

The newly proposed Sepsis-3 definition has been the subject of great controversy and consternation since its publication in The Journal of the American Medical Association (JAMA) on February 23, 2016.  That controversial definition discarded the concept of SIRS...

Coding of Pneumonia with COPD

In its 2016 Third Quarter edition, Coding Clinic clarified the use of the following two ICD-10 codes: J44.0:  Chronic obstructive pulmonary disease with acute lower respiratory infection J44.1:  Chronic obstructive pulmonary disease with (acute) exacerbation...

Deep Vein Thrombosis

Case:  A 78 year old female is admitted to the hospital with GI bleeding. Past medical history includes deep vein thrombosis (DVT) for which she has had a Greenfield filter placed in the inferior vena cava (IVC) and been maintained on Xarelto for 2 years....

Demand Ischemia

Case:  A 70 year old female multiple myeloma is admitted with rapid atrial fibrillation, substernal chest pressure and mild dyspnea. EKG shows non-specific changes. Hemoglobin is 7.5 gm/dl. Stool occult blood is negative. Atrial fib is converted with cardizem and...

Excisional Debridement

Case:  A patient is taken to operating room for I&D (incision and drainage) of abscess. Operative report states: “I&D performed using #16 scalpel, large amount purulent drainage, some necrotic tissue, wound cleaned and irrigated, drain placed.”  Is a...

HIV Disease

A 47 year old female with a past medical history of “HIV” was admitted with abscess and cellulitis of the thighs which were treated with IV Vancomycin, Ceftaz and Clindamycin. She had been recently hospitalized for disseminated herpes zoster with cervical...
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