The provider never documented pulmonary embolism. Do we have a choice for principal diagnosis in this example? Based on the circumstances of admission and the existing documentation, the only option for principal diagnosis is UTI. A query related to pulmonary embolism would have been appropriate because the patient had signs and symptoms related to it on admission dyspnea on exertion, tachycardia, elevated D Dimer and it was treated heparin, Eliquis even though the CT PE only showed small peripheral emboli.
What final corresponding diagnosis, if any, would the provider be willing to add to explain the symptoms? The DVT was not supported as principal diagnosis. After study, it does not appear to be the condition necessitating the inpatient status. The presenting signs and symptoms of weakness, fatigue, dysuria support UTI as the principal diagnosis. Although UTI does not always require inpatient care, it does appear to be the reason for admission in this case, especially since a diagnosis of sepsis was ruled out.
Sometimes, when the patient is transferred to the facility, the intent of the transfer will take sequencing priority over other conditions the patient brings with them.
If the other conditions could have been treated appropriately at the first facility, then they would not be sequenced as the principal diagnosis at the second facility. The reason for the transfer would be sequenced as the principal diagnosis.
For example, a patient was transferred from facility A to facility B due to worsening kidney function. The patient was originally admitted to facility A five days prior to transfer due to sepsis with an infected heel ulcer and was treated with IV antibiotics.
According to the documentation, the patient received an incision and debridement at facility A for treatment of the heel ulcer. It was planned for the patient to receive further surgical debridement at facility A. However, due to the worsening kidney function, the surgery could not be completed at facility A at that time and the patient was transferred to facility B for care of the acute kidney failure.
The principal diagnosis is the reason intent for transfer — the acute kidney failure. After the kidney function improved, the patient underwent surgery for care of the left heel. Neither the sepsis nor the heel ulcer should be sequenced as principal diagnosis at facility B because they did not necessitate the transfer for care. Before finalizing the principal diagnosis selection, the coding professional also needs to apply any official coding guideline or convention that takes precedence and directs that one condition is sequenced as principal diagnosis over another condition.
A good example of this is sepsis due to pneumonia. Although both conditions can necessitate inpatient admission, meet admission criteria and stand alone as the reason for admission, the sepsis coding guideline states that the systemic infection must be sequenced as principal diagnosis over the localized infection which does not allow for a choice between the two conditions; therefore, sepsis is sequenced as principal diagnosis.
There are definitely a lot of things to consider when selecting the all-important principal diagnosis. Happy sequencing! It can also help to establish whether new variants are associated with particular patterns of symptoms or severity of disease. In the initial stages of the epidemic, sequencing can be used to find out how many new cases of disease are imported or come from local transmission.
Mathematical models of how viruses evolve during an epidemic — developed from extensive analysis of past outbreaks — allow epidemic growth rates and other measurements of transmission and infection to be estimated from virus genome sequences.
Importantly, they provide independent validation of estimates of the size and growth rate of an epidemic. This is useful especially when cases are under-reported, for instance because many people who are infected do not have symptoms.
Widespread sampling and genome sequencing of the new coronavirus allows the reconstruction of virus spread in different places or groups of people. This provides information about what is driving the spread of the virus both locally and nationally. This work can be made more precise if virus genomes are combined with information about where, how and when people travel locally and internationally. Virus genome sequences can also identify unique genetic changes shared by all those infected in a single virus transmission chain.
This can be used to distinguish whether two clusters of cases in the same area have arisen because one started infection in the other, or because there were two distinct and independent chains of transmission with separate, earlier origins. Virus genomes can therefore add to the information provided by patient contact tracing, which is important for tracking outbreaks in communities, hospitals and other care settings.
Many genetic changes that occur in the genome of the virus will have no significant effect on the course of infection or disease, or the impact of control measures. However, a few of the changes might be important. These need to be identified and tracked through time. Databases that store information and facilitate communication and information sharing facilitate sequence evaluation.
Discoveries of the surprising extent of individual variations in the Discoveries of the surprising extent of individual variations in the genome have propelled us into the era of personalized and precision medicine.
Increasingly molecular techniques to analyze consequences of specific gene mutations and their downstream effects on gene regulation, protein functions, have potential to lead to potential therapeutic insights. Nucleic Acid analysis and mutation detection have already started to play an important role in Point-of-care testing, that gives immediate results in non-laboratory settings to support more patient-centered approaches to healthcare delivery.
Tumors evolve over the course of time and ongoing genomic studies provide guidance to oncologists regarding treatment options. Identification of genetic abnormalities in specific cancers have facilitated design of targeted therapies that frequently have dramatic positive effects. Liquid biopsies, the analysis of cell free DNA in plasma and cerebrospinal fluid have been successfully used to determine treatment efficacy, and to reveal metastases and to analyze the mechanisms by which specific cancers become resistant to targeted therapies.
0コメント