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...

Case Study: 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. She...

Case Study: 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 2...

Case Study: 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 query...

Case Study: Pneumonia vs. Aspiration Pneumonia

Case: An 85 year old male with past history of CVA and GERD is admitted from home for RLL “community acquired” pneumonia (CAP) and treated with Rocephin and Zithromax. Documentation throughout the record including discharge summary is CAP except ID consult on day 2...

Case Study: Sepsis with Bacteremia

Case:  A 75 year old woman is admitted with UTI, fever 101.5, altered mental status, tachycardia, BUN 50 and WBC 15,000.  Admission diagnosis is “severe UTI with leukocytosis and dehydration”.  Treatment includes IV Cipro 400mg q12h and aggressive IV fluid...

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...