Acute post-operative respiratory insufficiency
Not sure if this has already been asked; I searched the forum and didn't find anything.
We have noticed that when trying to code acute post-operative respiratory insufficiency, the code you get is R06.89, Other abnormalities of breathing, which is not a CC/MCC. However, if you choose "pulmonary" instead of "respiratory" in the coding pathway, you end up at J95.2, Acute pulmonary insufficiency following nonthoracic surgery, which is a MCC. It also seems like a much more accurate code for when a physician is documenting acute post-operative respiratory insufficiency. We are wondering what other CDI groups are doing with this. Are the terms "respiratory" and "pulmonary" interchangeable in this case? Do you query to get the physicians to use "pulmonary"? Are we making a mountain out of a molehill?
Thanks for any insight!
Sarah Jackson, RN, BSN
Clinical Documentation Specialist
We have noticed that when trying to code acute post-operative respiratory insufficiency, the code you get is R06.89, Other abnormalities of breathing, which is not a CC/MCC. However, if you choose "pulmonary" instead of "respiratory" in the coding pathway, you end up at J95.2, Acute pulmonary insufficiency following nonthoracic surgery, which is a MCC. It also seems like a much more accurate code for when a physician is documenting acute post-operative respiratory insufficiency. We are wondering what other CDI groups are doing with this. Are the terms "respiratory" and "pulmonary" interchangeable in this case? Do you query to get the physicians to use "pulmonary"? Are we making a mountain out of a molehill?
Thanks for any insight!
Sarah Jackson, RN, BSN
Clinical Documentation Specialist
Comments
You know as a nurse it makes sense that they be used interchangeably, but at our facility the coders will not take them as interchangeable. We do query for the "pulmonary" vs. respiratory.
On DATE documentation in the NOTE TYPE section of the medical record indicates the patient has ***.
Please clarify the nature of the patient's respiratory status occurring in the post-operative period. You may answer this query by marking the checkbox(es) below or using free text at the ( * ) if appropriate. Provider Query Response:*The patient is on mechanical ventilator for a routinely expected time frame to assure competency of the upper airway as part of normal recovery, as is usual and customary for this procedure, requiring no unusual or unexpected resources Respiratory failure is present as a post-operative complication of surgery on DATE ***, as evidenced by an unanticipated need to extend mechanical ventilation and/or gas exchange that is physiologically required to prevent or treat decompensation Respiratory failure is present and is related to patient’s other conditions / co-morbidities, or other non-surgical cause – please specify* Unable to determine
The purpose of this query is to ensure accurate coding, severity of illness and risk of mortality compilation. When responding to this query, please exercise your independent professional judgment. The fact that a question is asked does not imply that any particular answer is desired or expected.Paul Evans, RHIA, CCDS
Paul did you have to do education on this? I think a provider might not understand what the question is exactly?
It seems like respiratory failure is really all you are asking for...? I understand what information you are seeking ( is it a complication of surgery or related to an underlying disease process) but the words that are codaeable are the same respiratory failure. It seems clearly the problem is kind of silly basically. How can there be different codes for pulmonary vs respiratory insufficiency (acute), when you can't find true definitions in medical literature or medical dictionary...? I understand people feeling like querying with a word choice change borders on ethics ( I think Dr. Gold had some concerns in this area)...BUT why have the different code then? and why not use it if it exists... if you are really trying to convey a resource consumption? it's frustrating when these oddities are discovered they don't get corrected in subsequent publications.
It creates unnecessary confusion. I think AHIMA coming out with a position paper guideline that conflicts with coding guidelines is wrong as well. guidelines supersede, and they include coding possible. So when the position paper says we strongly recommend not using possible- it makes people follow the statement- though in fact it contradicts the OFFICIAL CODING GUIDELINES.
An Aline insertion has RW of 5.XXX ...more heavily weighted then a major bowel surgery. Silly.
So others opinions are great in the end sometimes we keep having repeated discussion because the problems are the codes themselves NOT our understanding of them.
Mistakes that make no sense happen... but fix them then...
Hi..time limited...I posted an 'anti-query' as too often 'acute PO respiratory failure' is charted on P.O. day zero in a stable patient after planned procedure and recovering on MV. Examine the query and the intent and focus is 'different'...yes, you agree, the language in the coding books is not congruent w/ clinical practice. I really do not 'want' often to report PO ARF as it is often charted w/ clinical support..please see this query in detail...the font is being skewed when I post it here. Query below is issued when charted and is seeking clarity as to existence and etiology, if any.
On DATE documentation in the NOTE TYPE section of the medical record indicates the patient has ***.
Please clarify the nature of the patient's respiratory status occurring in the post-operative period. You may answer this query by marking the checkbox(es) below or using free text at the ( * ) if appropriate. Provider Query Response:*1. The patient is on mechanical ventilator for a routinely expected time frame to assure competency of the upper airway as part of normal recovery, as is usual and customary for this procedure, requiring no unusual or unexpected resources 2. Respiratory failure is present as a post-operative complication of surgery on DATE ***, as evidenced by an unanticipated need to extend mechanical ventilation and/or gas exchange that is physiologically required to prevent or treat decompensation 3. Respiratory failure is present and is related to patient’s other conditions / co-morbidities, or other non-surgical cause – please specify* Unable to determine
The purpose of this query is to ensure accurate coding, severity of illness and risk of mortality compilation. When responding to this query, please exercise your independent professional judgment. The fact that a question is asked does not imply that any particular answer is desired or expected.Good query examples Paul.
"How can there be different codes for pulmonary vs respiratory insufficiency (acute), when you can't find true definitions in medical literature or medical dictionary...? I understand people feeling like querying with a word choice change borders on ethics ( I think Dr. Gold had some concerns in this area)...BUT why have the different code then? and why not use it if it exists... if you are really trying to convey a resource consumption? it's frustrating when these oddities are discovered they don't get corrected in subsequent publications.
It creates unnecessary confusion. I think AHIMA coming out with a position paper guideline that conflicts with coding guidelines is wrong as well. guidelines supersede, and they include coding possible. So when the position paper says we strongly recommend not using possible- it makes people follow the statement- though in fact it contradicts the OFFICIAL CODING GUIDELINES.
An Aline insertion has RW of 5.XXX ...more heavily weighted then a major bowel surgery. Silly. "
The other problem with the aline is that coding clinic is directing this coding. I think they have done so twice. ( I think...)
Question: The patient, who developed acute hypoxic respiratory failure and septic shock, underwent placement of an arterial line. The operative notes states that the upper artery was accessed using ultrasound guidance, the catheter was then advanced and sutured in place. What is the appropriate ICD-10-PCS code assignment for placement of an arterial catheter? Answer: For facilities wishing to track this information, assign the following ICD-10-PCS code, if desired:03HY32Z Insertion of monitoring device into upper artery, percutaneous approach, for insertion of the arterial catheter
Arterial catheterization should be coded as: Insertion of monitoring device, using the percutaneous approach and the appropriate body part value based on the documented position of the catheter tip. If the catheter tip location is not documented, the default body part value is upper artery. Although the insertion of monitoring device is coded, it is not required that the continuous monitoring be
My understanding is the the "insufficiency" code does NOT trigger a PSI, but does give you the MCC. Is that incorrect? I just checked the AHRQ manual and it looks like the codes that trigger the PSI are the "failure" codes. I also wouldn't query for this if the patient has an expected period of mechanical ventilation postoperatively. I'm looking more at the patient who goes to a higher level of care than expected d/t respiratory issues, whether that be high-flow oxygen, aggressive nebulization, BiPap, etc.
It sounds like a query would be needed, as well as education of providers. Thanks everyone!
Sarah
Thanks