AHA Coding Clinic® for ICD-9 - 2005 Issue 2; Ask the Editor

Dehydration and Pancreatic Malignancy with Liver Metastasis

The patient, a 91-year-old woman, was admitted for progressive weakness with signs and symptoms of dehydration. The physician determined that the patient had hepatic encephalopathy and acute liver failure. Further work-up revealed a mass at the head of the pancreas most likely pancreatic cancer and liver metastasis. Because the patient was neither a surgical candidate nor a candidate for any aggressive therapy, she received supportive and comfort care only. Would the guideline for coding and sequencing complications associated with malignant neoplasm apply, since the patient was initially admitted with dehydration? The guideline states “When the admission/encounter is for the management of dehydration due to the malignancy or therapy, or a combination of both, and only the dehydration is being treated (intravenous rehydration), the dehydration is sequenced first, followed by the code(s) for the malignancy.” What should be assigned as the principal diagnosis? ...

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