Respiratory failure as principal diagnosis
Hello CDI Talkers-I'm seeking input on a common scenario here at my
hospital. We have many patients admitted with acute and sometimes acute
on chronic respiratory failure due to an underlying pulmonary condition;
e.g., COPD exacerbation, pneumonia, or pulmonary fibrosis. We always
have a hard time determining principal diagnosis in these cases. The
existing coding guidance really has not been helpful-it seems to consist
mostly of "refer to the circumstances of the admission".
Do any of you have a philosophy/algorithm/process for determining
principal diagnosis in these cases? It's a little easier when the
patient does not have chronic respiratory failure, I think. The acute
respiratory failure usually turns around quickly and most of the
hospitalization is directed toward treatment of the underlying pulmonary
condition. It's harder when they have chronic respiratory failure,
because then you're dealing with an exacerbation of a chronic condition.
Your thoughts please.
Cathy L. Seluke, RN, BSN, ACM, CCDS
Supervisor Clinical Documentation Compliance
MaineGeneral Medical Center
Augusta and Waterville, Maine
P. 207.872.1796
F. 207.872.1594
Cathy.Seluke@mainegeneral.org
hospital. We have many patients admitted with acute and sometimes acute
on chronic respiratory failure due to an underlying pulmonary condition;
e.g., COPD exacerbation, pneumonia, or pulmonary fibrosis. We always
have a hard time determining principal diagnosis in these cases. The
existing coding guidance really has not been helpful-it seems to consist
mostly of "refer to the circumstances of the admission".
Do any of you have a philosophy/algorithm/process for determining
principal diagnosis in these cases? It's a little easier when the
patient does not have chronic respiratory failure, I think. The acute
respiratory failure usually turns around quickly and most of the
hospitalization is directed toward treatment of the underlying pulmonary
condition. It's harder when they have chronic respiratory failure,
because then you're dealing with an exacerbation of a chronic condition.
Your thoughts please.
Cathy L. Seluke, RN, BSN, ACM, CCDS
Supervisor Clinical Documentation Compliance
MaineGeneral Medical Center
Augusta and Waterville, Maine
P. 207.872.1796
F. 207.872.1594
Cathy.Seluke@mainegeneral.org