Mechanical Vent
Can anyone tell me if there is a coding clinic that indicates how to code a pt who is vented for protection of airway. Our physician indicated pt in acute respiratory failure but pt does not meet criteria of ARF. Chart indicated patient was electively intubated for airway protection. Any thoughts would be welcomed!!
Comments
Here's my take on it: If the patient is intubated and placed on a T
piece, obviously airway protection is the goal of the treatment.
However, if a cycled vent is used, is the patient not in respiratory
failure? If they are sedated (as the usually are) enough to depress
their respiratory drive enough so that they cannot breathe on their own,
that's respiratory failure in my book!
Looking forward to other thoughts on the matter.
Cathy Seluke, RN, BSN, ACM, CCDS
Supervisor Clinical Documentation Compliance
MaineGeneral Medical Center
149 North Street
Waterville, ME 04901
Phone (207) 872-1796
Fax (207) 872-1519
Cathy.Seluke@mainegeneral.org
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
When we have patients intubated for airway protection we will query the physician. One of the choices we give is dependent on mechanical vent. This will code to V46.11.
We do not expect them to document,nor will they document respiratory failure since the patient was not intubated due to respiratory failure.
Our charts have been audited and this has not been an issue for us. The respiratory failure diagnosis being coded for a patient intubated for airway protection has been an issue.
necessarily in respiratory failure, but what is the difference between
"ventilator dependent" and respiratory failure? If you can't maintain
gas exchange adequate to sustain your life, that's respiratory failure.
Why would the reason for intubation matter? The patient may or may not
progress to respiratory failure.
The way I see it, airway protection and maintaining gas exchange are two
different (albeit related) treatments.
Cathy Seluke, RN, BSN, ACM, CCDS
Supervisor Clinical Documentation Compliance
MaineGeneral Medical Center
149 North Street
Waterville, ME 04901
Phone (207) 872-1796
Fax (207) 872-1519
Cathy.Seluke@mainegeneral.org
If a patient was not in respiratory failure and was intubated to protect their airway - such as a pt admitted with angioedema - they were not in respiratory distress at the time they were admitted but the physicians were concerned about airway protection and the patient agreed to be intubated.
The patient is, at that point, dependent on the vent but they are not and were not in resp failure.
I have had circumstances where pts were intubated for airway progression but failed extubation trials - some even requiring a trach - at that point our physicians will document respiratory failure.
We have had these charts reviewed by outside auditors and, at times, have lost the resp failure as an MCC when the pt was intubated for airway protection.
It's a very fine line.