nonleading query for chronic respiratory failure?

Unknown

I have a patient admitted with:

Pneumonia (PDx)
and
longstanding COPD (with exacerbation)
Chronic O2 use
Cor pulmonale
Blood carbon dioxide 34-40 this admission
Continuous O2 use 1-3 liter this admission

I would like to write a query for possible respiratory failure:

This patient presents with the above documented diagnoses, treatment and lab results. Do you feel the above secondary diagnoses represent the patients most accurate clinical picture? If not could you document (an) additional diagnosis completeness?

--------
Is this an appropriate query? And nonleading?

Thank-you for your input.

Charlene

robert.hodges2

This is a really tough question. I think the query is OK and not leading, but I'm afraid your doctor may not give you the chronic respiratory failure. I know I had a conversation here with my pulmonologist about patients who are O2 dependent being in chronic respiratory failure, and he said sometimes yes and sometimes no. I was also helping do some training at another facility recently and one of the coders said that when they asked their doc for a definition of chronic respiratory failure the answer was "death".

Perhaps if you had something with definitions of respiratory insufficiency and respiratory failure with the query (to give a couple of options) along with the scripting you have below (would also ask if the condition was acute or chronic in nature) that may help get what you are looking for. I know for example on my chronic kidney disease query I have the staging guidelines from the national kidney foundation.

This is a tough one and it's not normally something I query for because of the providers reluctance to document that. But, bottom line, I think your query looks good form my stand point. I'm also attaching a copy of my respiratory symptoms form for your review. It may help. I'd be curious how it turns out.

Robert

Robert S. Hodges, BSN, MSN, RN
Clinical Documentation Improvement Specialist
Aleda E. Lutz VAMC
Mail Code 136
1500 Weiss Street
Saginaw MI 48602
 
P: 989-497-2500 x13101
F: 989-321-4912
E: Robert.Hodges2@va.gov
 
"Anyone who has never made a mistake has never tried anything new." -Albert Einstein 

Unknown

Robert could you resend this attachment in an older form? I can't open it.
Thanks.

Gina Spatafore, RN
Clinical Documentation Integrity Specialist
203 573 7647

Unknown

Thank-you Robert. I often will provide choices but fear it would make the query a one - I already have the other diagnoses that might be appropriate.

Thanks for including your acute respiratory symptoms form. You have a lot of good information on it.

Charlene

robert.hodges2

Here you go. Hopefully it will work now

Robert

Robert S. Hodges, BSN, MSN, RN
Clinical Documentation Improvement Specialist
Aleda E. Lutz VAMC
Mail Code 136
1500 Weiss Street
Saginaw MI 48602

robert.hodges2

That's what I like about this list serve Charlene. Everyone tries to help and are willing to share

Hang in there!

Robert

Robert S. Hodges, BSN, MSN, RN
Clinical Documentation Improvement Specialist
Aleda E. Lutz VAMC
Mail Code 136
1500 Weiss Street
Saginaw MI 48602
 
P: 989-497-2500 x13101
F: 989-321-4912
E: Robert.Hodges2@va.gov
 
"Anyone who has never made a mistake has never tried anything new." -Albert Einstein 

sbeatty

When I was working on diagnosis-specific queries, I asked one of our pulmonologists what criteria would be appropriate as findings to generate a clarification request from us. I had reviewed the literature and took those articles/criteria with me, but you must know how your own physicians feel about the assignment of such diagnoses. His caveat to me was that beyond home O2, he would want to see daily scheduled (and used) nebs, and maintenance steroids before he would feel comfortable with a diagnosis of chronic respiratory failure. I asked specifically about "end-stage" COPD, as that's a very popular phrase with our medical staff. Without the above criteria, he says chronic respiratory failure wouldn't necessarily be appropriate every time. When I took the standardized query form with acute and chronic respiratory failure criteria to the Medical Staff Quality Management Committee, the chief of pulmonology was there and supported the criteria because they had participated in outlining what findings justified that diagnosis for them. Since often our pulmonologists are called in to manage the acute phase of respiratory illness, we need them on board so we don't end up with conflicting documentation between them and the attending.

Is there anything else I can do for you?
Clinical Quality Management would like your feedback on our ability to meet your needs. Please complete a satisfaction survey for our department.

Sandy Beatty, RN, BSN, C-CDI
Clinical Documentation Specialist
Columbus Regional Hospital
Columbus, IN
(812) 376-5652
sbeatty@crh.org

"Obstacles are those frightful things you see when you take your eyes off the goal." Hannah More

sbeatty

I guess it might have been nice if I included the form!! Early drafts of many of these are on the website under Tools and Forms.

Is there anything else I can do for you?
Clinical Quality Management would like your feedback on our ability to meet your needs. Please complete a satisfaction survey for our department.

Sandy Beatty, RN, BSN, C-CDI
Clinical Documentation Specialist
Columbus Regional Hospital
Columbus, IN
(812) 376-5652
sbeatty@crh.org

"Obstacles are those frightful things you see when you take your eyes off the goal." Hannah More

robert.hodges2

Great definition of Chronic Respiratory Failure Sandy. Mind if I borrow it for review by my medical staff here and potential inclusion in my respiratory symptoms query form?

Robert

Robert S. Hodges, BSN, MSN, RN
Clinical Documentation Improvement Specialist
Aleda E. Lutz VAMC
Mail Code 136
1500 Weiss Street
Saginaw MI 48602

fentona@bronsonhg.org

Charlene,
This is the form we use here. I was a collaborative effort with our intesivists, pulmonologists and hospitalists. It has been very successful. 3M saw it their last visit as well with only good things to say. My understanding is it is not leading due to multiple choices and other as an option.
Hope it helps,
Amy

Amy Fenton, RN
Clinical Documentation Specialist
Clinical Operations Improvement
Bronson Methodist Hospital
601 John Street - Box 59
Kalamazoo, MI 49007
Office: (269) 341-8442
Fax: (269) 341-8330
Pager: (269) 513-3131
E-Mail: fentona@bronsonhg.org

sbeatty

ok

Is there anything else I can do for you?
Clinical Quality Management would like your feedback on our ability to meet your needs. Please complete a satisfaction survey for our department.

Sandy Beatty, RN, BSN, C-CDI
Clinical Documentation Specialist
Columbus Regional Hospital
Columbus, IN
(812) 376-5652
sbeatty@crh.org

"Obstacles are those frightful things you see when you take your eyes off the goal." Hannah More

blefevre

Hello everyone,
Here is the query form that we use in our hospital. It seems to work well. In the narrative part, we include the criteria and ask if there is a respiratory diagnosis for the criteria.

sbeatty

Sorry for the curt reply, but I'm in training for CDIS, 3M's new cdi software. We're doing classroom exercises, and I'm trying to read email and answer in between!! Feel free to use any of the work I've done. We're all in this together. If you get feedback that is negative or questioning, please let me know. I'd be interested in hearing about any concerns.

Is there anything else I can do for you?
Clinical Quality Management would like your feedback on our ability to meet your needs. Please complete a satisfaction survey for our department.

Sandy Beatty, RN, BSN, C-CDI
Clinical Documentation Specialist
Columbus Regional Hospital
Columbus, IN
(812) 376-5652
sbeatty@crh.org

"Obstacles are those frightful things you see when you take your eyes off the goal." Hannah More

tiffany_susan

If you are asking if you have enough for Chronic failure? Absolutely

Thank You,
Susan Tiffany RN, CCDS
Supervisor Clinical Documentation Program
Guthrie Healthcare System
phone: 570-882-6094, pager #465
fax: 570-882-6768
email: tiffany_susan@guthrie.org
"Twenty years from now you will be more disappointed by the things you
didn't do than by the ones you did do. So throw off the bowlines. Sail
away from safe harbor.Catch the trade winds in your sails. Explore. Dream.
Discover." Mark Twain

Unknown

Thank-you everyone.
I spoke with the physician this morning and as I was listing the clinical findings, he said ,
"Oh, this patient has chronic respiratory failure".



Information on the query:

Clinical finding or medical record documentation:

Pneumonia

longstanding COPD (with exacerbation)

Chronic O2 use

Cor pulmonale

Blood carbon dioxide 34-40 this admission

Continuous O2 use 1-3 liter this admission



Question:

This patient presents with the above documented diagnoses, treatment and lab results. Do you feel the above secondary diagnoses represent the patients most accurate clinical picture? If not could you document (an) additional diagnosis completeness?

Charlene

ctrygar

There is a good example for querying respiratory failure in the AHIMA Managing and effective query process.
I use this one however, I do leave a descripition of the idividual patient ex copd pt on chronic oxygen therapy with blood co2 level of ____ and so forth. I then list possible choices like in the AHIMA article. I also spoke with a pulmonologist here reguarding defining chronic resp failure, he said if the patient has an underlying resp issue (fibrosis, copd etc.) and they require continuous 02 he said if you take away there o2 they would probably decompensate thus he considers that chronic resp failure.

cheri

judithbates

That is a great explanation of Chronic respiratory failure and actually is what I use a the basis when I query for anyone who is O2 dependent.

Judi Bates RN, BSN, CCDS
CDI Specialist
856-757-3161
Beeper 66x2906