Knowledge Base Article

Q:

1. If an inpatient has a cardiac arrest and does not survive CPR, do you code the ICD-10-CM diagnosis of Cardiac Arrest?

Hospitals thoughts and current coding:

We have not been coding the ICD-10-CM code for cardiac arrest if the patient does not survive the code. The discharge disposition reflects the death of the patient.   The cardiac arrest code provides medical necessity for the CPR procedure code, but everyone’s heart will arrest at the time of death. It will not be everyone’s cause of death.  We ensure that all other conditions that meet the appropriate UHDDS definitions are coded so that the severity of illness and risk of mortality are appropriately captured.                   

2. How do you correctly code CPR in ICD-10-PCS? Does it differ if the patient survives the code?

Hospitals thoughts and current coding:

We have only been coding the “CPR” code: 5A12012 Performance of Cardiac Output Single, Manual.

If the patient was intubated, bagged or defibrillated in addition to the manual chest compressions during CPR, should we code those root operations separately? 

INTUBATION:  The PCS Desk Reference states that if an endotracheal tube is inserted to maintain an airway in patients who are unconscious or unable to breathe on their own, intubation should be coded to the root operation INSERTION.  Does this apply to CPR?

The PCS guideline for devices states that the device should not be coded unless that device remains after the procedure is completed.  If the patient survives and is placed on a ventilator, yes we code the intubation and ventilation.  What if the patient doesn’t survive the code? Should we code the intubation?   Not all physicians intubate their patients when CPR is performed.  Not all physicians use the same method with each patient.   We never see them document “intubated for airway protection” (although it makes sense that airway protection is the reason).  Does the physician need to document intubated for airway protection during CPR in order to code the intubation, even if the patient does not survive?

A:

According to Coding Clinic 1st Qtr. 2013 page 10, you would report a code for cardiac arrest whether or not the patient was resuscitated.  Sequencing of cardiac arrest would depend on the circumstances of the admission and whether the source of the arrest were known.

You would code each method obtained to resuscitate the patient including intubation.  More than likely they aren’t going to intubate the patient unless they plan on placing the patient on a BiPap/Vent.