CHF vs Respiratory Failure as Principal Diagnosis

ggoodman@virginiahospitalcenter.com

Does anyone have easily available a coding clinic that talks about the sequencing of CHF and Acute Respiratory Failure if both diagnosis are present on admission. Of note it is later mentioned that the Acute Respiratory Failure was due to a CHF exacerbation. Trying to determine if Acute Respiratory Failure or CHF Exacerbation should be the principal Diagnosis.

Thanks!
Greta


**********************************************************************************************************
This e-mail and any files transmitted with it are confidential and are intended solely for the use of the individual or entity to whom they are addressed. This communication may contain personal patient health care information and is protected by federal law and other statutory protections. If you are not the intended recipient or the individual responsible for delivering the e-mail to the intended recipient, please be advised that you have received this e-mail in error and that any use, dissemination, forwarding, printing, or copying of this e-mail or any attached files is strictly prohibited. If you have received this e-mail in error, please promptly delete this message and notify the sender of the delivery error by e-mail or you may call Virginia Hospital Center -Arlington's Information Systems Department @703-558-6566.

***********************************************************************************************************

ssalinas

As with all cases, it depends on the admission circumstances, diagnostic workup and/or treatment provided, etc. I pasted 2 CCs below: the first deals with Resp Failure and CHF; the second discusses Respiratory Failure and other acute conditions with 2 dx meeting definition of principal dx.

Respiratory failure and congestive heart failure

katysuegood@gmail.com

I agree. In the CC below, the MD has clearly documented that the Resp failure was the reason for admission. This makes it easy. However, we rarely have this kind of documentation and this is when it gets sticky. If the patient ends up on the vent and you are trying to capture this resource to get into DRG 207/208 I think the argument is that the vent is treated at a higher level than the CHF (though both dx and the tx are obviously related). However, I have found with our coders that if the MD documents that the resp failure is 2/2 the CHF, they want to use the CHF as Pdx. I have never seen anything that suggests that this is a "rule" though. Just what they are comfortable with.

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

katysuegood@gmail.com

Oops. That should say the Resp failure is treated at a higher level because of the Vent...

sorry

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

catladyrn

The fact that two diagnoses are POA doesn't necessarily mean either one can be taken as PDx. I look at each diagnosis and ask myself, could this diagnosis, standing alone, have been the reason the decision to admit was made. If so, then I can use it, noting of course, the exceptions mandated by coding guidelines (such as sepsis). The treatment plan is certainly a consideration in making that determination, and if the diagnoses are truly co-equal, there's nothing wrong with going for the higher RW.

JMNSHO,

Renee

Linda Renee Brown, RN, CCRN, CCDS, CDIP