Coding, Classification & Reimbursement

Sequencing of respiratory failure

  • 1.  Sequencing of respiratory failure

    Posted 07-19-2018 20:22
    ​​We are having a discussion regarding the sequencing of the following: the provider documented "acute hypoxic respiratory failure secondary to COPD, CAP and CHF." Since the respiratory failure is secondary to these conditions, I believe it should be coded as a secondary diagnosis. CDI maintains respiratory failure should be coded as the PDX because "more resources being used for the respiratory failure, transfer to MICU and BiPAP, and that is was one of the reasons for admission." Your thoughts?

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    Linda Mizerski
    Independent Auditor/Coder, Educator
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  • 2.  RE: Sequencing of respiratory failure

    Posted 07-20-2018 09:01
    Coding Clinic  4th qt 2008 page 241-244, addresses this.

    3) Sequencing of acute respiratory failure and another acute condition

     

    When a patient is admitted with respiratory failure and another acute condition, (e.g., myocardial infarction, cerebrovascular accident, aspiration pneumonia), the principal diagnosis will not be the same in every situation. This applies whether the other acute condition is a respiratory or nonrespiratory condition. Selection of the principal diagnosis will be dependent on the circumstances of admission. If both the respiratory failure and the other acute condition are equally responsible for occasioning the admission to the hospital, and there are no chapter-specific sequencing rules, the guideline regarding two or more diagnoses that equally meet the definition for principal diagnosis (Section II, C.) may be applied in these situations.

     

    If the documentation is not clear as to whether acute respiratory failure and another condition are equally responsible for occasioning the admission, query the provider for clarification.



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    Kay Patterson
    Coding Quality/Education Coordinator
    Vanderbilt Medical Center
    Nashville, Tennessee
    kay.patterson@vanderbilt.edu
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  • 3.  RE: Sequencing of respiratory failure

    Posted 07-21-2018 02:25
    Edited by Josefino Lim 07-21-2018 02:31
    As the coding instruction states" selection of principal diagnosis will be dependent on the circumstances of admission"..... most of the time acute respiratory failure resolves after the etiology ( respiratory or non respiratory ) is adequately treated and stabilized and the treatment for the etiology continues until the patient is discharged.... the acute respiratory failure is usually treated with intubation and mechanical ventilation which usually is 96H at most while the treatment for the etiology of the  acute respiratory is continued.....e.g.. AMI w CHF w Resp Failure... patient intubated/mech ventilated for 96 H... AMI treated with control of CHF, Cardiac Cath/Stenting, Coronary vasodilators after the acute phase with Resp Failure..... this is the total picture of the " circumstances of admission" which includes the length of stay, the diagnostics done and the treatment provided....the AMI is sequenced as Prin Dx in this case based on the circumstances of admission..
    There will be cases in which the patient will be unable to be weaned from mechanical ventilation and after several trials with  weaning failures, the patient will be Trached...... then in this case Ac Resp Failure can be sequenced as Prin Dx..... this clinical cases exemplifies the meaning of "circumstances of admission"..

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    Josefino Lim
    CODER II
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