Subtherapeutic INR
Can Z51.81 Encounter for therapeutic drug level monitoring be used as the primary diagnosis in this case of an 87 y/o male with a history of Aortic and Mitral Valve replacements in the past but consulted the ER for numbness and tingling of the hands and chest pain. He incidentally was found to have subtherapeutic levels of INR. Upon nursing assessment, numbness and tingling, and chest pain are resolved. MD ordered for the SN to administer subcutaneous Lovenox and PT/INR monitoring. Patient is unable to self-administer due to vision problem. Could anyone suggest a diagnosis for this scenario? Thanks, and appreciate your help.
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Nancy Wolverton RN,CCM
QR Specialist, Central Office
5800 West 10th St., Suite 300
Little Rock, AR. 72205
Ph# 501-280-4913
Fax# 501-280-4385
Nancy.Wolverton@arkansas.gov
The acute event is as stated in the documentation rec’d by the agency:
Acute symptoms: numbness and tingling, chest pain (resolved prior to HH vst)
ER MD found: found to have subtherapeutic levels of INR
Referral to HH: Administer Lovenox and monitor INR.
The vision impairment is chronic. The drug (not specified but assumed Coumadin) is monitored via INR’s for therapeutic levels.
The Lovenox is administered as a low weight heparin bridge while the (anticoagulant) reaches therapeutic levels, therefore preventing a stroke/clot formation
The anticog is subtherapeutic. That is the reason for the HH, to get this patient back to therapeutic levels at which time the Lovenox will be DC’d once the (anticoag) therapeutic dose is established. The vision loss adds to the supportive medical necessity for HH.
Nancy Wolverton RN,CCM
QR Specialist, Central Office
5800 West 10th St., Suite 300
Little Rock, AR. 72205
Ph# 501-280-4913
Fax# 501-280-4385
Nancy.Wolverton@arkansas.gov