Question

76 year old morbidity obse white male, was admited

A 76-var-old morbidly obese white male was admitted to the facility with an acute exacerbation of COPD. He is a previous smoker, but has not smoked for the past year because his breathing issues have continued to worsen. He was started on oxygen and treated with an oral corticosteroid with prophylactic antibiotics administered. The progress note of day two states that the pressure ulcer of his right heel (stage 4) was non-excisionally debrided at the bedside As an auditor you review the POA status, code assignment, and DRG assignment shown below for this patient's stay. You conclude there is an error 1. What is the error and what impact does it have on reimbursement! 2. What action might need to be taken to justify your conclusion of a coding error? POA status DRG assignment 192 (199) ICD-10-CM codes assigned J44.1 L89.614 E66.01 287.891 Winat 192

1) what is the error and what impact foes it have on remburesement?

2)What action might need to be taken to justifay your conclusion

Answer 1

1. The error happened here is this case is coded as Z87.891 diagnosis code in the secondary codes which is actually a code for nicotine dependence. This cannot be reimbursed because it indicates that patient is having a personal history of nicotine and insurance cannot be reimbursed as his situation is because of his addiction.

2. In this case it clearly shows that patient had stopped smoking from past 1 year and is not on current use.

So correction to be made in the code. Add CPT codes of 99046 or 99047 which states patient became symptomatic with nicotine use or diagnosis code as Z72.0 should be added that Nicotine dependent disorder.

Smoker rates and non smoker reimbursed rates will be differed and according to the time periods of the insurance registered.