PDI #9 Conundrum

Wanted to get the group's opinion on the following scenario (abbreviated):

Infant was admitted to PICU with known history of pulmonary hypertension (on sildenafil and bosentan) and readmitted with crisis. Stabilized, then went to OR for fundoplication (believed that GER was contributing to acute pulmonary hypertensive crises). Returned intubated on vent, extubated within  24-48 hours. Was reintubated shortly thereafter due to respiratory distress/desaturations/code white episode and started on iNO. Physician documented that respiratory failure was due to postextubation airway edema and pulmonary hypertensive crisis. Coder coded as postoperative respiratory failure.

I initially questioned this, as the CDI Handbook states that if respiratory failure occurs due to another identifiable cause in the postop period it should not be assigned the code for postoperative respiratory failure (the guidance, however is a little confusing). But, when I look at AHRQ criteria for PDI #9 (Postop Resp Failure Rate) it states the numerator contains discharges with any secondary diagnosis code for acute respiratory failure.

Now I am wondering if I am just splitting hairs: If quality is going to capture as postop respiratory failure regardless, is there a need to clarify?

How do your institutions address this?

Thanks in advance,
Jackie Touch, MSN, RN CCM

Comments

  • I've had a similar issue.  If I don't query for the EXACT dx (i.e. "cellulitis" vs "surgical site infection") will quality not capture it?  It becomes an ethical issue!
    Thanks for posting, interested in answers!
    thanks,
    cari
  • I usually ask the attending to document 'acute resp failure as expected due to airway edema and acute pulmonary hypertension'
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