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UNGROUPABLE DRG

Mary Posted Thu 18th of October, 2012 21:09:08 PM

Patient was admitted due to postoperative ileus-I have used 997.49 for this but when I tried to abstract a message claimed that this was ungroupable-should I have used 560.1 as principal dx and use 997.49 as secondary? This is very confusing-I appreciate any help!

SuperCoder Answered Fri 19th of October, 2012 01:19:54 AM

An ileus commonly occurs following gastrointestinal surgery, and usually requires added treatment, nursing care and in some cases, an increase in the length of stay. Some coding professionals would argue that in checking the ICD-9-CM codebook index, you are lead to code 997.49, digestive system complications, and 560.1, paralytic ileus, when postoperative ileus is documented. This is true if you only code from the index, but ICD-9-CM coding rules require that you also check the tabular for accurate coding assignment. The tabular describes code 997.42, as other digestive system complications. It would appear that the physician would need to be queried for clarification as to whether the ileus is indeed a complication of the surgery. Let us refer back to The ICD-9-CM Official Guidelines for Coding and Reporting, Complications of Surgery and Other Medical Care, which by its title alone, tell us that the complication is due to the surgery or procedure. Most physicians do not consider an ileus occurring in the postoperative period to be a complication of the surgery, but rather an expected surgical outcome. When this is the case, only the ileus, 560.1, should be reported. Again, querying the physician for clarification is often needed for accurate code assignment.

http://californiahia.org/sites/californiahia.org/files/docs/CDQarticles/2012-02-coding-postop-complications.pdf

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