Respiratory Failure

ggoodman@virginiahospitalcenter.comggoodman@virginiahospitalcenter.com
in Clinical & Coding
Does anyone have any good definitions for Respiratory Failure, with a cited source?
Looking for...
1)Acute Respiratory Failure (I am curious at what o2 sat on room air and below you believe qualifies for acute respiratory failure).
2)Chronic Respiratory Failure
3) Acute on Chronic Respiratory Failure
4) Post Operative Pulmonary Insufficiency

Thanks!
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
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Comments

  • mdomineseymdominesey
    edited March 2016
    -
  • mary.a.dunnmary.a.dunn
    edited March 2016
    Does it really matter since you will end up with a trach DRG. That would trump any other codes and have a high severity of illness "built in"




    From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
    Sent: Thursday, August 09, 2012 6:52 AM
    To: Mary A. Dunn
    Subject: [cdi_talk] Respiratory failure

    If a patient has documentation on arrival from pulmonary "pre op hypoxemic respiratory failure", proceeds to surgery and has documentation of "post op respiratory failure" which is prolonged leading to trach is there any way to capture both conditions? Both conditions are present, monitored and treated but our coding manager notes coding guidelines indicate the two codes should not be used in conjunction with one another. For severity of illness on arrival I would think the 518.81 POA 'y' would be important to capture. Has anyone had a similar scenario and how was it coded?

    Thanks!




    ---
  • laura.mancinilaura.mancini
    edited March 2016
    If you don't capture the acute respiratory failure on arrival you aren't accurately capturing the severity of illness when the patient presented to the facility.

    From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
    Sent: Thursday, August 09, 2012 8:12 AM
    To: Mancini Laura
    Subject: RE:[cdi_talk] Respiratory failure

    Does it really matter since you will end up with a trach DRG. That would trump any other codes and have a high severity of illness "built in"




  • cynthia.a.goeweycynthia.a.goewey
    edited March 2016
    I agree...I would use the acute respiratory failure and not the post-op failure code. I work hard with our physicians so we can accurately capture the SOI on admission.
    Cindy

  • mdomineseymdominesey
    edited March 2016
    I too would code the Acute Respiratory Failure from admission. No sense in making the coded record show that the surgery was related to the Failure when it was already there on admission.

    Mark







    Mark N. Dominesey, RN, BSN, MBA, CCDS
    Sr. Clinical Documentation Improvement Specialist
    Sibley Memorial Hospital
    Information Technology
    5255 Loughboro Rd NW
    Washington DC, 20016-2695
    W: 202.660.6782
    http://www.sibley.org
    mdominesey@sibley.org
  • evanspx@sutterhealth.orgevanspx@sutterhealth.org
    edited March 2016
    Pre-op respiratory failure is classified differently than respiratory failure following surgery - the pre-op failure would be due to some underlying cause, such as COPD, CHF, etc.


    Reporting two codes would indicate the pt was admitted in respiratory failure due to some process and also that the pt incurred a 2nd type of respiratory failure 'due to surgery' - for obvious reasons, I would use the 518.5 Series, Pulmonary Insufficiency following surgery with great caution.

    All in all, this truly 'sounds' like only one form of respiratory failure, that being what 'bought the bed' previous to surgery - however, it is feasible for a pt to have both, just be aware of the quality implications for the hospital and medical staff because when we report 518.5 (failure after surgery ) the POA will be no and we are reporting the patient was


    1. Admitted in respiratory failure due to ?CHF/COPD & POA = Y

    2. Went into a 2nd and separate form of failure after surgery & POA = N


    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
    From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
    Sent: Thursday, August 09, 2012 5:24 AM
    To: Evans, Paul
    Subject: RE:[cdi_talk] Respiratory failure

    I agree...I would use the acute respiratory failure and not the post-op failure code. I work hard with our physicians so we can accurately capture the SOI on admission.
    Cindy

    From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
    Sent: Thursday, August 09, 2012 8:16 AM
    To: Cynthia A. Goewey
    Subject: RE:[cdi_talk] Respiratory failure

    If you don't capture the acute respiratory failure on arrival you aren't accurately capturing the severity of illness when the patient presented to the facility.

    From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
    Sent: Thursday, August 09, 2012 8:12 AM
    To: Mancini Laura
    Subject: RE:[cdi_talk] Respiratory failure

    Does it really matter since you will end up with a trach DRG. That would trump any other codes and have a high severity of illness "built in"




    From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
    Sent: Thursday, August 09, 2012 6:52 AM
    To: Mary A. Dunn
    Subject: [cdi_talk] Respiratory failure

    If a patient has documentation on arrival from pulmonary "pre op hypoxemic respiratory failure", proceeds to surgery and has documentation of "post op respiratory failure" which is prolonged leading to trach is there any way to capture both conditions? Both conditions are present, monitored and treated but our coding manager notes coding guidelines indicate the two codes should not be used in conjunction with one another. For severity of illness on arrival I would think the 518.81 POA 'y' would be important to capture. Has anyone had a similar scenario and how was it coded?

    Thanks!




  • hooter1964hooter1964
    Jeff,
    One thing I can tell you is there are no dumb questions on this forum! With that being said I would like the Pediatric Experts to chime in .
  • mark.domineseymark.dominesey
    edited March 2016
    Hi, As far as I know, ABGs are not necessary for a diagnosis of Acute Respiratory Failure, so this is enough to appeal the denial.

    Even if the person had/has Chronic Respiratory Failure, there are enough clinical interventions done as well as enough clinical indicators to account for an Acute Decompensation. (sats in the 80's, extreme SOB, AMS, central cyanosis, requirement for O2 double the one they need in a chronic stable state, etc).

    Mark



    From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
    Sent: Friday, April 04, 2014 12:03 PM
    To: Mark Dominesey
    Subject: [cdi_talk] Respiratory Failure

    Hi All,
    We just recently became involved in clinical indicator denials (FINALLY!!!) and I have a question about one I am working on. We have a denial for respiratory failure in which the patient's highest 02 requirement was 4L NC and had documented RA sats in the 80's. We have no ABG's drawn. She ended up being discharged on 2 liters and the insurer is stating that the resp failure was not acute but rather chronic in nature and doesn't meet criteria for ARF (despite documentation by the MD).
    I am wondering if this is one I should attempt to fight? And if so, under what definition of resp failure? We do not have institutional definitions (yet).

    Thanks!


    Katy Good, RN, BSN, CCDS, CCS
    Clinical Documentation Program Coordinator
    AHIMA Approved ICD-10CM/PCS Trainer
    Flagstaff Medical Center
    Kathryn.Good@nahealth.com
    Cell: 928.814.9404




    ---

  • annnd2009@gmail.comannnd2009@gmail.com
    edited March 2016
    I think 2l to 4 is a stretch. Room air sat of 80? Why did they get room
    air if she lives on 2l? I thought I learned ra to 4l might qualify but if
    baseline is 2?

    It made me question further a case at my facility that I did not feel was
    substantiated for this reason. It is a case with baseline 2l now requiring
    "3-4l". I personally think providers just over use our "buzz words" at
    times. I think we'll be seeing more of this.
    Ann
    Ann.donnelly@sclhs.net

    Sent from my iPhone

    On Apr 4, 2014, at 10:34 AM, CDI Talk wrote:

    Hi, As far as I know, ABGs are not necessary for a diagnosis of Acute
    Respiratory Failure, so this is enough to appeal the denial.



    Even if the person had/has Chronic Respiratory Failure, there are enough
    clinical interventions done as well as enough clinical indicators to
    account for an Acute Decompensation. (sats in the 80's, extreme SOB, AMS,
    central cyanosis, requirement for O2 double the one they need in a chronic
    stable state, etc).



    Mark







    *From:* CDI Talk [mailto:cdi_talk@hcprotalk.com ]
    *Sent:* Friday, April 04, 2014 12:03 PM
    *To:* Mark Dominesey
    *Subject:* [cdi_talk] Respiratory Failure



    Hi All,

    We just recently became involved in clinical indicator denials (FINALLY!!!)
    and I have a question about one I am working on. We have a denial for
    respiratory failure in which the patient's highest 02 requirement was 4L NC
    and had documented RA sats in the 80's. We have no ABG's drawn. She ended
    up being discharged on 2 liters and the insurer is stating that the resp
    failure was not acute but rather chronic in nature and doesn't meet
    criteria for ARF (despite documentation by the MD).

    I am wondering if this is one I should attempt to fight? And if so, under
    what definition of resp failure? We do not have institutional definitions
    (yet).



    Thanks!





    Katy Good, RN, BSN, CCDS, CCS

    Clinical Documentation Program Coordinator

    AHIMA Approved ICD-10CM/PCS Trainer

    Flagstaff Medical Center

    Kathryn.Good@nahealth.com

    Cell: 928.814.9404





    ---

  • evanspx@sutterhealth.orgevanspx@sutterhealth.org
    edited March 2016
    1. 4L on NC equates roughly to FI02 of about 36% oxygen


    2. Absence of ABG Testing.



    There may be instances in which a record may document "acute respiratory failure' in the absence of ABG testing. The medical staff may chose not to perform ABG testing for a terminal patient that is DNR, for instance. While important, ABG testing should be the not be the sole determinant, a patient must also exhibit increased work of breathing - CC 2nd Qtr, 1990.

    "Arterial blood gas determinations are only one of the supportive clinical findings. Other determinations must be taken into consideration before the diagnosis of respiratory failure is determined"... A patient with acute respiratory failure usually presents with increased work of breathing as typified by rapid respiratory rate, use of accessory muscles of respiration (such as intercostal muscle retraction), and possibly paradoxical breathing and/or cyanosis."

    An oxygen saturation level of < 88% corresponds to a p02 50 mm Hg. Therefore, look for a corresponding oxygen saturation level in patients documented as having acute respiratory distress when ABG levels are not performed. Such a level in a patient with severe dyspnea at rest with a rapid respiratory rate and/or accessory intercostals muscle use and/or paradoxical abdominal motion may be experiencing acute respiratory failure. * Source: AHIMA 2006 Audio Seminar Series, Sepsis, slide 66

    If the record documents acute respiratory failure and the patient has severe hypoxemia with an O2 Saturation < 88% AND the patient exhibits other signs of respiratory failure, such as Tachycardia, Tachypnea, Use of Accessory Muscles, Inability to speak in full sentences, and Cyanosis, it may be possible to advocate acute respiratory failure as a valid diagnosis. Use discretion as ABG testing is the "gold standard" in regards to the diagnosis of respiratory failure



    3. Supplemental oxygen

    Per emedicine.medscape.com/article/167981 (updated 8/24/122

  • cmorellcmorell
    edited March 2016
    Paul-
    As always, you are awesome! You rock it outta the park!
    Thank you for always sharing your thoughts and for always giving us such valuable source citation.

    You are the best!

    Charlie Morell
  • evanspx@sutterhealth.orgevanspx@sutterhealth.org
    edited March 2016
    Charlie - As we say in Cali...."no worries".

    Paul

    Paul Evans, RHIA, CCS, CCS-P, CCDS
     
    Manager, Regional Clinical Documentation & Coding Integrity
    Sutter West Bay
    633 Folsom St., 7th Floor, Office 7-044
    San Francisco, CA 94107
    Cell:  415.637.9002

    evanspx@sutterhealth.org



    -
  • hooter1964hooter1964
    Katy,
    I definitely would fight this. I always question why anyone is placed on supplemental Oxygen. I ask them if we "are we running an oxygen Bar' or 'is there a failure of a body system". The bottom line is Normal Values were created for a reason and I am sure you and I have an O2 Sat that is 96-99%. If we were placed on 4 liters we would remain at 99%. So when I see someone on 2 to 4 liters and they are only 91-92% I ask the provider if this a new finding or a normal value for them. That is simply not Normal.

    * Hypoxic Respiratory Failure is defined as:
    a PaO2 value of less than 60 mmHg on room air equivalent to SpO2
  • katysuegood@gmail.comkatysuegood@gmail.com
    edited March 2016
    Thank you everyone for the feedback. Sorry, I have been busy working on other things but am getting back to this now.

    The issue I am running into in this record is that she was discharged on 2L of o2. The discharge summery states: 'Acute hypoxemic respiratory failure: The patient was noted to be hypoxemic. At night when she sleeps she dips down to 86%. She oxygenates well when she is awake. She will be discharged with home oxygen to be used nocturnally at 2 liters by nasal cannula.'

    This was a new issue for her, she was not on home 02 prior. So, they are arguing that this was a chronic issue and she never required much more 02, (she was on 3-4 L at times, though I will admit that its unclear whether she really required 3-4L or if that’s just where the nurse put her) than her (new) baseline, so they do not consider this acute Resp failure.

    I am going to make a stab at arguing for the dx but I do feel like it is somewhat weak. I would not have recommended a query for acute resp failure in this instance. I would have pushed for chronic though....

    Katy Good, RN, BSN, CCDS, CCS
    Clinical Documentation Program Coordinator
    AHIMA Approved ICD-10CM/PCS Trainer
    Flagstaff Medical Center
    Kathryn.Good@nahealth.com
    Cell: 928.814.9404

    -----Original Message-----
    From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
    Sent: Saturday, April 05, 2014 7:02 AM
    To: Kathryn Good
    Subject: re:[cdi_talk] Respiratory Failure

    Katy,
    I definitely would fight this. I always question why anyone is placed on supplemental Oxygen. I ask them if we "are we running an oxygen Bar' or 'is there a failure of a body system". The bottom line is Normal Values were created for a reason and I am sure you and I have an O2 Sat that is 96-99%. If we were placed on 4 liters we would remain at 99%. So when I see someone on 2 to 4 liters and they are only 91-92% I ask the provider if this a new finding or a normal value for them. That is simply not Normal.

    * Hypoxic Respiratory Failure is defined as:
    a PaO2 value of less than 60 mmHg on room air equivalent to SpO2
  • charlenet@chaduath.comcharlenet@chaduath.com
    edited March 2016
    2016 CDI Pocket Guide lists as follows:



    Chronic Respiratory Failure 2016 CDI Pocket Guide



    Definition

    Chronic respiratory failure is caused by abnormalities of oxygenation and carbon dioxide elimination due to chronic lung disease. As with acute respiratory failure it may be classified as hypoxic, hypercapnic or unspecified.



    Acute on chronic respiratory failure represents an acute exacerbation/decompensation of pre-existing chronic respiratory failure.



    Common causes include severe COPD, pulmonary fibrosis, interstitial lung disease and cystic fibrosis.





    Diagnostic Criteria



    * Hypoxemic of variable severity (often with baseline p02
  • katysuegood@gmail.comkatysuegood@gmail.com
    edited March 2016
    Count me in as confused! At least we are in it together? ;-)

    I agree with you too on the Home 02 paul. We generally are not seeing people on home 02 who's sats are allowed to sit so low. I'm feeling like we virtually never have patients that meet this criteria (that I am aware of) and we certainly have chronic resp failure documented.... Hmmm...

    Katy Good, RN, BSN, CCDS, CCS
    Clinical Documentation Program Coordinator
    AHIMA Approved ICD-10CM/PCS Trainer
    Flagstaff Medical Center
    Kathryn.Good@nahealth.com
    Cell: 928.814.9404

    From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
    Sent: Wednesday, January 06, 2016 9:55 AM
    To: Kathryn Good
    Subject: RE:[cdi_talk] Respiratory Failure

    I am confused, too.

    I must say I 'almost never' see pts on 24 hour oxygen @ 6 L to maintain 81%. (not contesting the definition, and always love to receive such advice - just saying I personally rarely see 6L documented for home use)?

    PE

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

    Manager, Regional Clinical Documentation & Coding Integrity
    Sutter West Bay
    633 Folsom St., 7th Floor, Office 7-044
    San Francisco, CA 94107
    Cell: 415.412.9421

    evanspx@sutterhealth.org

  • lsipos@monument.healthlsipos@monument.health
    edited March 2016
    The CDI pocket guide states “patients who qualify for home 02 almost always have chronic respiratory failure and a baseline pO2 < 60mmHg. …. “ So, I think it is how you read it, and…….

    Our providers MANY times do not get and ABG so the pO2 wouldn’t lend itself as support. Our PULM Intensivist supports chronic resp failure as a diagnosis with clinical picture of pt (ie. sob, tachypnea, home O2 use and an issue such as COPD exacerbation. It is when the question of ACUTE resp failure arises that he does ABG’s).

    As with all diagnosis, I think the entire clinical picture, resource consumption, reason for admission, evaluation of a diagnosis, etc have to be considered. NO black and white as we all know!

    Juli
    From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
    Sent: Wednesday, January 06, 2016 10:18 AM
    To: Bovard, Juli
    Subject: Re: [cdi_talk] Respiratory Failure

    I don't see the reference stating on 6L... Am I missing it?

    Sent from my iPhone

    On Jan 6, 2016, at 8:55 AM, CDI Talk wrote:
    I am confused, too.

    I must say I ‘almost never’ see pts on 24 hour oxygen @ 6 L to maintain 81%. (not contesting the definition, and always love to receive such advice – just saying I personally rarely see 6L documented for home use)?

    PE

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

    Manager, Regional Clinical Documentation & Coding Integrity
    Sutter West Bay
    633 Folsom St., 7th Floor, Office 7-044
    San Francisco, CA 94107
    Cell: 415.412.9421

    evanspx@sutterhealth.org



  • sharon.cooper@owensborohealth.orgsharon.cooper@owensborohealth.org
    Well said Juli!

    Sharon Cooper, RN-BC, CCS, CDIP, CCDS, CHTS-CP
    AHIMA-Approved ICD-10-CM/PCS Trainer/Ambassador
    Manager Clinical Documentation/Appeals

    Owensboro Health Regional Hospital
    P.O. Box 20007
    Owensboro, KY 42304-0007
    Office: 270-417-4612
    Cell: 270-316-9088
    Fax: 1-270-417-4609

    From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
    Sent: Wednesday, January 06, 2016 11:32 AM
    To: Sharon Cooper
    Subject: RE: [cdi_talk] Respiratory Failure

    The CDI pocket guide states “patients who qualify for home 02 almost always have chronic respiratory failure and a baseline pO2 < 60mmHg. …. “ So, I think it is how you read it, and…….

    Our providers MANY times do not get and ABG so the pO2 wouldn’t lend itself as support. Our PULM Intensivist supports chronic resp failure as a diagnosis with clinical picture of pt (ie. sob, tachypnea, home O2 use and an issue such as COPD exacerbation. It is when the question of ACUTE resp failure arises that he does ABG’s).

    As with all diagnosis, I think the entire clinical picture, resource consumption, reason for admission, evaluation of a diagnosis, etc have to be considered. NO black and white as we all know!

    Juli
    From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
    Sent: Wednesday, January 06, 2016 10:18 AM
    To: Bovard, Juli
    Subject: Re: [cdi_talk] Respiratory Failure

    I don't see the reference stating on 6L... Am I missing it?

    Sent from my iPhone

    On Jan 6, 2016, at 8:55 AM, CDI Talk wrote:
    I am confused, too.

    I must say I ‘almost never’ see pts on 24 hour oxygen @ 6 L to maintain 81%. (not contesting the definition, and always love to receive such advice – just saying I personally rarely see 6L documented for home use)?

    PE

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

    Manager, Regional Clinical Documentation & Coding Integrity
    Sutter West Bay
    633 Folsom St., 7th Floor, Office 7-044
    San Francisco, CA 94107
    Cell: 415.412.9421

    evanspx@sutterhealth.org



    From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
    Sent: Wednesday, January 06, 2016 8:49 AM
    To: Evans, Paul
    Subject: RE:[cdi_talk] Respiratory Failure

    Thanks Dr. Gold. I feel very confused about querying for this diagnosis. It seems from all of your information that this diagnosis is being overused.

    Syndi Hudson, RN, CCDS,CCM
    CHRISTUS Santa Rosa New Braunfels
    CDI Specialist
    cynthia.hudson@christushealth.org
    830-643-6116 (Office)
    830-643-5139 (Fax)

    “We are His hands”. Isaiah 64:8

    From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
    Sent: Wednesday, January 06, 2016 10:29 AM
    To: Hudson, Cynthia
    Subject: RE:[cdi_talk] Respiratory Failure

    Beware, all. There is much too much freedom in inappropriate documenting and coding of chronic respiratory failure. Just use of home oxygen is NOT diagnostic of chronic respiratory failure but implies chronic hypoxia. Most patients do NOT meet criteria for chronic hypoxemic respiratory failure. Beware of asking too many questions because the docs will start calling everyone "chronic respiratory failure." I promise, the hospital and the country's data will suffer. The patient must met the criteria of either
  • lsipos@monument.healthlsipos@monument.health
    ☺ Thanks Sharon!

    From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
    Sent: Wednesday, January 06, 2016 10:34 AM
    To: Bovard, Juli
    Subject: RE: [cdi_talk] Respiratory Failure

    Well said Juli!

    Sharon Cooper, RN-BC, CCS, CDIP, CCDS, CHTS-CP
    AHIMA-Approved ICD-10-CM/PCS Trainer/Ambassador
    Manager Clinical Documentation/Appeals

    Owensboro Health Regional Hospital
    P.O. Box 20007
    Owensboro, KY 42304-0007
    Office: 270-417-4612
    Cell: 270-316-9088
    Fax: 1-270-417-4609

    From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
    Sent: Wednesday, January 06, 2016 11:32 AM
    To: Sharon Cooper
    Subject: RE: [cdi_talk] Respiratory Failure

    The CDI pocket guide states “patients who qualify for home 02 almost always have chronic respiratory failure and a baseline pO2 < 60mmHg. …. “ So, I think it is how you read it, and…….

    Our providers MANY times do not get and ABG so the pO2 wouldn’t lend itself as support. Our PULM Intensivist supports chronic resp failure as a diagnosis with clinical picture of pt (ie. sob, tachypnea, home O2 use and an issue such as COPD exacerbation. It is when the question of ACUTE resp failure arises that he does ABG’s).

    As with all diagnosis, I think the entire clinical picture, resource consumption, reason for admission, evaluation of a diagnosis, etc have to be considered. NO black and white as we all know!

    Juli
    From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
    Sent: Wednesday, January 06, 2016 10:18 AM
    To: Bovard, Juli
    Subject: Re: [cdi_talk] Respiratory Failure

    I don't see the reference stating on 6L... Am I missing it?

    Sent from my iPhone

    On Jan 6, 2016, at 8:55 AM, CDI Talk wrote:
    I am confused, too.

    I must say I ‘almost never’ see pts on 24 hour oxygen @ 6 L to maintain 81%. (not contesting the definition, and always love to receive such advice – just saying I personally rarely see 6L documented for home use)?

    PE

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

    Manager, Regional Clinical Documentation & Coding Integrity
    Sutter West Bay
    633 Folsom St., 7th Floor, Office 7-044
    San Francisco, CA 94107
    Cell: 415.412.9421

    evanspx@sutterhealth.org



    From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
    Sent: Wednesday, January 06, 2016 8:49 AM
    To: Evans, Paul
    Subject: RE:[cdi_talk] Respiratory Failure

    Thanks Dr. Gold. I feel very confused about querying for this diagnosis. It seems from all of your information that this diagnosis is being overused.

    Syndi Hudson, RN, CCDS,CCM
    CHRISTUS Santa Rosa New Braunfels
    CDI Specialist
    cynthia.hudson@christushealth.org
    830-643-6116 (Office)
    830-643-5139 (Fax)

    “We are His hands”. Isaiah 64:8

    From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
    Sent: Wednesday, January 06, 2016 10:29 AM
    To: Hudson, Cynthia
    Subject: RE:[cdi_talk] Respiratory Failure

    Beware, all. There is much too much freedom in inappropriate documenting and coding of chronic respiratory failure. Just use of home oxygen is NOT diagnostic of chronic respiratory failure but implies chronic hypoxia. Most patients do NOT meet criteria for chronic hypoxemic respiratory failure. Beware of asking too many questions because the docs will start calling everyone "chronic respiratory failure." I promise, the hospital and the country's data will suffer. The patient must met the criteria of either
  • cynthia.hudson@christushealth.orgcynthia.hudson@christushealth.org
    Thanks Juli!

    Syndi Hudson, RN, CCDS,CCM
    CHRISTUS Santa Rosa New Braunfels
    CDI Specialist
    cynthia.hudson@christushealth.org
    830-643-6116 (Office)
    830-643-5139 (Fax)
    [CCDS_pin_1inch]
    “We are His hands”. Isaiah 64:8

    From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
    Sent: Wednesday, January 06, 2016 11:34 AM
    To: Hudson, Cynthia
    Subject: RE: [cdi_talk] Respiratory Failure

    Well said Juli!

    Sharon Cooper, RN-BC, CCS, CDIP, CCDS, CHTS-CP
    AHIMA-Approved ICD-10-CM/PCS Trainer/Ambassador
    Manager Clinical Documentation/Appeals

    Owensboro Health Regional Hospital
    P.O. Box 20007
    Owensboro, KY 42304-0007
    Office: 270-417-4612
    Cell: 270-316-9088
    Fax: 1-270-417-4609

    From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
    Sent: Wednesday, January 06, 2016 11:32 AM
    To: Sharon Cooper
    Subject: RE: [cdi_talk] Respiratory Failure

    The CDI pocket guide states “patients who qualify for home 02 almost always have chronic respiratory failure and a baseline pO2 < 60mmHg. …. “ So, I think it is how you read it, and…….

    Our providers MANY times do not get and ABG so the pO2 wouldn’t lend itself as support. Our PULM Intensivist supports chronic resp failure as a diagnosis with clinical picture of pt (ie. sob, tachypnea, home O2 use and an issue such as COPD exacerbation. It is when the question of ACUTE resp failure arises that he does ABG’s).

    As with all diagnosis, I think the entire clinical picture, resource consumption, reason for admission, evaluation of a diagnosis, etc have to be considered. NO black and white as we all know!

    Juli
    From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
    Sent: Wednesday, January 06, 2016 10:18 AM
    To: Bovard, Juli
    Subject: Re: [cdi_talk] Respiratory Failure

    I don't see the reference stating on 6L... Am I missing it?

    Sent from my iPhone

    On Jan 6, 2016, at 8:55 AM, CDI Talk wrote:
    I am confused, too.

    I must say I ‘almost never’ see pts on 24 hour oxygen @ 6 L to maintain 81%. (not contesting the definition, and always love to receive such advice – just saying I personally rarely see 6L documented for home use)?

    PE

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

    Manager, Regional Clinical Documentation & Coding Integrity
    Sutter West Bay
    633 Folsom St., 7th Floor, Office 7-044
    San Francisco, CA 94107
    Cell: 415.412.9421

    evanspx@sutterhealth.org



    From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
    Sent: Wednesday, January 06, 2016 8:49 AM
    To: Evans, Paul
    Subject: RE:[cdi_talk] Respiratory Failure

    Thanks Dr. Gold. I feel very confused about querying for this diagnosis. It seems from all of your information that this diagnosis is being overused.

    Syndi Hudson, RN, CCDS,CCM
    CHRISTUS Santa Rosa New Braunfels
    CDI Specialist
    cynthia.hudson@christushealth.org
    830-643-6116 (Office)
    830-643-5139 (Fax)

    “We are His hands”. Isaiah 64:8

    From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
    Sent: Wednesday, January 06, 2016 10:29 AM
    To: Hudson, Cynthia
    Subject: RE:[cdi_talk] Respiratory Failure

    Beware, all. There is much too much freedom in inappropriate documenting and coding of chronic respiratory failure. Just use of home oxygen is NOT diagnostic of chronic respiratory failure but implies chronic hypoxia. Most patients do NOT meet criteria for chronic hypoxemic respiratory failure. Beware of asking too many questions because the docs will start calling everyone "chronic respiratory failure." I promise, the hospital and the country's data will suffer. The patient must met the criteria of either
  • cari.merlina@uchealth.orgcari.merlina@uchealth.org
    Just emailed Melissa the Respiratory and Renal tools.

    Best Regards,

    Cari Merlina RN, BSN
    Clinical Documentation Improvement Specialist
    Revenue Cycle
    Yampa Valley Medical Center
    p.970.871.2425
    f.970.875.2796
    Cari.merlina@yvmc.org







    -----Original Message-----
    From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
    Sent: Thursday, February 11, 2016 1:03 PM
    To: Merlina, Cari
    Subject: RE: [cdi_talk] Respiratory failure

    Can you send it to Melissa at ACDIS and she can upload it to the Forms & Tools library?

    -----Original Message-----

    Friends,
    This site says my file is too big to send the ACP position paper. Just email me and I'm glad to send it to you as an attachment.

    Best Regards,

    Cari Merlina RN, BSN
    Clinical Documentation Improvement Specialist Revenue Cycle Yampa Valley Medical Center
    p.970.871.2425
    f.970.875.2796
    Cari.merlina@yvmc.org

    ---
    CDI Talk is offered for networking purposes. For official rules and regulations related to documentation and coding, please refer to your regulatory source.

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    Copyright 2013
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    ---
    CDI Talk is offered for networking purposes. For official rules and regulations related to documentation and coding, please refer to your regulatory source.

    You are receiving this message as a member of CDI Talk as: Cari.Merlina@yvmc.org If you would like to be removed from CDI Talk, please send a blank email to leave-cdi_talk-20336902.a0626d9483f8984bb855a807cafad7dc@hcprotalk.com
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    Copyright 2013
    HCPro, Inc., 75 Sylvan Street, Danvers MA 01923



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