Post Op... Respiratory Failure vs Pulmonary Insufficiency

ggoodman@virginiahospitalcenter.comggoodman@virginiahospitalcenter.com
edited May 2016 in CDI Talk Archive
Hello All!
We are having a discussion at our facility about what to call "respiratory failure" following surgery.
For example if a patient remains on a vent following surgery for a day or two because they cannot be extuabted.
Or if a patient is extubated and then needs reintubated.
Or even if they get off the vent but still need bipap, venti mask, NRB, lots of O2 NC, etc.
Should this be called "Acute Respiratory Failure" or "Acute Post Operative Pulmonary Insufficiency?"
What are the pros and cons of each? Does one count more towards a surgery complication than the other?
Does one affect a physician profile more than another?
We are just trying to figure out what the best term to use in this case is.
Any resources or suggestions would be appreciated.
Thank you!
Greta



Greta Goodman
Clinical Documentation Improvement Specialist
Health Information Management
Virginia Hospital Center
1701 North George Mason Drive
Arlington, VA 22205
703-558-5336
ggoodman@virginiahospitalcenter.com

Comments

  • mdomineseymdominesey
    edited May 2016
    I understand Respiratory Failure to not include ventilation up to two days post-op; meaning it is probably not good to code it/query for it unless the post-op intubation lasts longer than 48 hrs after surgery. That being said, I would have no problem querying for "Post-op Acute Respiratory Failure" should a patient be extubated and reintubated at any time after surgery as long as it is not documented as a "weaning trial", or some amount of time passed between extubation and reintubation. Obviously you would not call a extubation and reintubation Respiratory Failure if they had to reintubate within minutes after extubating. After a few hours, I believe it to be safe to query for it.

    MND


    Mark N. Dominesey, RN, BSN, MBA, CCDS, CDIP
    Sr. Clinical Documentation Improvement Specialist
    Sibley Memorial Hospital

    Information Technology
    5255 Loughboro Rd NW
    Washington DC, 20016-2695

    W: 202.660.6782
    F: 202.537.4477

    [cid:image001.gif@01CD1C7F.556996E0]
    http://www.sibley.org

  • sharon.colesharon.cole
    edited May 2016
    We had a really great meeting with our Pulmonologists about this subject. They agreed that post op vents (here it was mainly the hearts), were not in respiratory failure except due to anesthesia. One said "Well if you take them off the vent right now, they would not be able to breathe and that IS respiratory failure". After discussing coding/billing requirements, they agreed to not use the term respiratory failure for these cases. They have started documenting post op vent management - not sure how they are billing on their side.
    I will say that they had a patient here recently that was not doing well on the vent post op, they were bagging the patient, did a bronch, etc and spent over an hour at the bedside working with the patient. I did feel that case was appropriate when they documented post op respiratory failure - but the coder did not, so it was not coded.

    Sharon Cole, RN, CCDS
    Providence Health Center
    Case Management Dept
    254.751.4256
    srcole@phn-waco.org
  • mdomineseymdominesey
    edited May 2016
    Post Op Respiratory Failure was proposed to be a SCIP measure but I have not been able to validate if it is actually being tracked yet.


    AHRQ Measures


    PSI 06 Iatrogenic pneumothorax, adult


    Ongoing


    Ongoing


    PSI 11 Post operative respiratory failure


    TBA


    2012



    Mark N. Dominesey, RN, BSN, MBA, CCDS, CDIP
    Sr. Clinical Documentation Improvement Specialist
    Sibley Memorial Hospital

    Information Technology
    5255 Loughboro Rd NW
    Washington DC, 20016-2695

    W: 202.660.6782
    F: 202.537.4477

    [cid:image001.gif@01CD1C80.21641090]
    http://www.sibley.org

  • catladyrncatladyrn
    I agree that you should wait about 2 days postoperatively before documenting or querying for respiratory failure due to failure to wean after surgery. That is the standard that I found in a review of the medical literature.

    It used to be that only the codes for acute respiratory failure would trigger PSI 11, postoperative respiratory failure, but AHRQ got wise this year and added the codes for respiratory failure after surgery.

    Renee

    Linda Renee Brown, RN, CCRN, CCDS
    Senior Consultant, CDI/Nursing
    Jacobus Consulting, Inc.
  • evanspx@sutterhealth.orgevanspx@sutterhealth.org
    edited May 2016
    I believe Dr. Gold posted information pertaining to this topic on our
    website - I know I read some good advice from him in regards to MV after
    Surgery. I also believe this topic will be discussed during our next
    quarterly call.



    Paul Evans, RHIA, CCS, CCS-P, CCDS



    Supervisor, Clinical Documentation Integrity, Quality Department

    California Pacific Medical Center

    2351 Clay #243

    San Francisco, CA 94115

    Cell: 415.637.9002

    Fax: 415.600.1325

    Ofc: 415.600.3739

    evanspx@sutterhealth.org

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