RE: Acute Respiratory Failure- to code or not to code (Paul)
Paul,
What is the source for the area highlighted below? I am familiar with 2011 CC but I don’t believe the highlighted statement is from that CC. I have seen it before but cannot remember the source. Could you help me out?
Thanks,
Sharon Salinas, CCS
Health Information Management
Barlow Respiratory Hospital
2000 Stadium Way, Los Angeles CA 90026
Tel: 213-250-4200 ext 3336
FAX: 213-202-6490
ssalinas@barlow2000.org
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Wednesday, May 06, 2015 1:47 PM
To: Salinas, Sharon
Subject: RE:[cdi_talk] Acute Respiratory Failure- to code or not to code
In the absence of a process causing acute respiratory failure after admission, such as COPD, or CHF, aspiration during the procedure, it is most often not correct to assign a code for ARF.
Pt’s are ‘always’ placed on MV after these procedures for protection of the airway.
Consider a pt with MVP is admitted and has no h/o any cardiopulmonary disease(s). After procedure, he is placed on MV for ‘respiratory failure’.
What caused the ARF? We have no code for COPD, CHF, PNA, etc. If assign the code for ARF, do we routinely place our pts in ARF after a MV procedure? The POA for the 518.51 will be “N”. Effect: Our data will show pts admitted for routine MV procedures going into ‘respiratory failure’ after our procedures, and the ARF was NOT present on admission….the ARF will also be our sole MCC.
Note: 518.81 is used for ARF 2/2 COPD, CHF, etc
518.51 is used for ARF following trauma/surgery.
My Rationale is here:
Postoperative Respiratory Failure
Many physicians document “acute respiratory failure” in the postoperative period, even though it is usual and customary for the procedure. This may occur when patients are maintained on a ventilator following surgery even though it is a routine and expected aspect of the patients care inherent to the procedure performed. In other words, the respiratory failure is due to the procedure, falls within the routinely expected time frame, and does not require unusual resources, thus should not be considered a complication nor coded as an additional diagnosis.
As the CDI team reviews charts, we will not ‘code’ postoperative respiratory failure if there is not clinical support for this decision – ‘best practice’ would be to state in our notes section that “518.5X noted”. We will not use the documentation of ARF when we compute our working MS-DRG on our Reconciliation Sheet. The final coding decision will be made by the coder.
It ‘may’ be appropriate to code if:
Ø Physician documents it as not routinely expected or as a complication of the procedure
Ø Physician documents as due to another cause or due to medications or anesthesia
Ø Mechanical Ventilation is required for more than 48 hours after surgery or reintubation with mechanical ventilation is performed
Effective October 1, 2011, codes 518.51, Acute respiratory failure following trauma and surgery; 518.52, Other pulmonary insufficiency, not elsewhere classified; and 518.53, Acute and chronic respiratory failure following trauma and surgery, have been created to distinguish postoperative acute respiratory failure from less severe respiratory conditions such as shock lung, drowned lung, pulmonary and lung insufficiency following shock, surgery or trauma, wet lung syndrome, adult respiratory distress syndrome (following shock, surgery, or trauma) and acute idiopathic lung congestion; conditions that only require supplemental oxygen or intensified observation.
Respiratory failure is a relatively common postoperative complication that often requires mechanical ventilation for more than 48 hours after surgery or reintubation with mechanical ventilation after postoperative extubation. Risk factors may be specific to the patient's general health, location of the incision in relation to the diaphragm, or the type of anesthesia used for surgery. Trauma to the chest can lead to inadequate gas exchange causing problems with levels of oxygen and carbon dioxide. Respiratory failure results when oxygen levels in the bloodstream become too low (hypoxemia), and/or carbon dioxide is too high (hypercapnia), causing damage to tissues and organs, or when there is poor movement of air in and out of the lungs. In all cases, respiratory failure is treated with oxygen and treatment of the underlying cause of the failure. Source: AHA Coding Clinic• for ICD-9-CM, 4Q 2011, Volume 28, Number 4, Pages 123-125
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
[cid:image001.jpg@01CE983E.025F5700]
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Wednesday, May 06, 2015 1:37 PM
To: Evans, Paul
Subject: RE:[cdi_talk] Acute Respiratory Failure- to code or not to code
Agree with routine postop vent would not be coded, but what about Acute resp failure?
Ellen
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Wednesday, May 06, 2015 3:34 PM
To: Chang, Ellen
Subject: RE:[cdi_talk] Acute Respiratory Failure- to code or not to code
Routine post-op ventilation should not be coded as far as I know.
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, May 06, 2015 2:22 PM
To: Kathryn Good
Subject: [cdi_talk] Acute Respiratory Failure- to code or not to code
I need your opinion please:
Patients come in for heart surgery, or major bowel surgeries.. Placed on vent postop, extubated w/in acceptable time. Pulmonologists and Intensivists sometimes would document “Acute respiratory failure, for vent management”. Our coders would code this as 518.81 which is not a complication code. Under AHRQ spec, this will not be considered as a complication. However, the Premier software is pulling this code (518.81) pairing with surgical procedures and marked this as a ‘postop complication’.
1. Do we code 518.81 or no?
2. No, we do not code as it is part of postop care after a major surgery.
3. What should physicians write for reason for consult if not “acute respiratory failure”?
Appreciate your help here.
Ellen
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Copyright 2013
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What is the source for the area highlighted below? I am familiar with 2011 CC but I don’t believe the highlighted statement is from that CC. I have seen it before but cannot remember the source. Could you help me out?
Thanks,
Sharon Salinas, CCS
Health Information Management
Barlow Respiratory Hospital
2000 Stadium Way, Los Angeles CA 90026
Tel: 213-250-4200 ext 3336
FAX: 213-202-6490
ssalinas@barlow2000.org
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Wednesday, May 06, 2015 1:47 PM
To: Salinas, Sharon
Subject: RE:[cdi_talk] Acute Respiratory Failure- to code or not to code
In the absence of a process causing acute respiratory failure after admission, such as COPD, or CHF, aspiration during the procedure, it is most often not correct to assign a code for ARF.
Pt’s are ‘always’ placed on MV after these procedures for protection of the airway.
Consider a pt with MVP is admitted and has no h/o any cardiopulmonary disease(s). After procedure, he is placed on MV for ‘respiratory failure’.
What caused the ARF? We have no code for COPD, CHF, PNA, etc. If assign the code for ARF, do we routinely place our pts in ARF after a MV procedure? The POA for the 518.51 will be “N”. Effect: Our data will show pts admitted for routine MV procedures going into ‘respiratory failure’ after our procedures, and the ARF was NOT present on admission….the ARF will also be our sole MCC.
Note: 518.81 is used for ARF 2/2 COPD, CHF, etc
518.51 is used for ARF following trauma/surgery.
My Rationale is here:
Postoperative Respiratory Failure
Many physicians document “acute respiratory failure” in the postoperative period, even though it is usual and customary for the procedure. This may occur when patients are maintained on a ventilator following surgery even though it is a routine and expected aspect of the patients care inherent to the procedure performed. In other words, the respiratory failure is due to the procedure, falls within the routinely expected time frame, and does not require unusual resources, thus should not be considered a complication nor coded as an additional diagnosis.
As the CDI team reviews charts, we will not ‘code’ postoperative respiratory failure if there is not clinical support for this decision – ‘best practice’ would be to state in our notes section that “518.5X noted”. We will not use the documentation of ARF when we compute our working MS-DRG on our Reconciliation Sheet. The final coding decision will be made by the coder.
It ‘may’ be appropriate to code if:
Ø Physician documents it as not routinely expected or as a complication of the procedure
Ø Physician documents as due to another cause or due to medications or anesthesia
Ø Mechanical Ventilation is required for more than 48 hours after surgery or reintubation with mechanical ventilation is performed
Effective October 1, 2011, codes 518.51, Acute respiratory failure following trauma and surgery; 518.52, Other pulmonary insufficiency, not elsewhere classified; and 518.53, Acute and chronic respiratory failure following trauma and surgery, have been created to distinguish postoperative acute respiratory failure from less severe respiratory conditions such as shock lung, drowned lung, pulmonary and lung insufficiency following shock, surgery or trauma, wet lung syndrome, adult respiratory distress syndrome (following shock, surgery, or trauma) and acute idiopathic lung congestion; conditions that only require supplemental oxygen or intensified observation.
Respiratory failure is a relatively common postoperative complication that often requires mechanical ventilation for more than 48 hours after surgery or reintubation with mechanical ventilation after postoperative extubation. Risk factors may be specific to the patient's general health, location of the incision in relation to the diaphragm, or the type of anesthesia used for surgery. Trauma to the chest can lead to inadequate gas exchange causing problems with levels of oxygen and carbon dioxide. Respiratory failure results when oxygen levels in the bloodstream become too low (hypoxemia), and/or carbon dioxide is too high (hypercapnia), causing damage to tissues and organs, or when there is poor movement of air in and out of the lungs. In all cases, respiratory failure is treated with oxygen and treatment of the underlying cause of the failure. Source: AHA Coding Clinic• for ICD-9-CM, 4Q 2011, Volume 28, Number 4, Pages 123-125
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
[cid:image001.jpg@01CE983E.025F5700]
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Wednesday, May 06, 2015 1:37 PM
To: Evans, Paul
Subject: RE:[cdi_talk] Acute Respiratory Failure- to code or not to code
Agree with routine postop vent would not be coded, but what about Acute resp failure?
Ellen
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Wednesday, May 06, 2015 3:34 PM
To: Chang, Ellen
Subject: RE:[cdi_talk] Acute Respiratory Failure- to code or not to code
Routine post-op ventilation should not be coded as far as I know.
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, May 06, 2015 2:22 PM
To: Kathryn Good
Subject: [cdi_talk] Acute Respiratory Failure- to code or not to code
I need your opinion please:
Patients come in for heart surgery, or major bowel surgeries.. Placed on vent postop, extubated w/in acceptable time. Pulmonologists and Intensivists sometimes would document “Acute respiratory failure, for vent management”. Our coders would code this as 518.81 which is not a complication code. Under AHRQ spec, this will not be considered as a complication. However, the Premier software is pulling this code (518.81) pairing with surgical procedures and marked this as a ‘postop complication’.
1. Do we code 518.81 or no?
2. No, we do not code as it is part of postop care after a major surgery.
3. What should physicians write for reason for consult if not “acute respiratory failure”?
Appreciate your help here.
Ellen
---
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: kathryn.good@nahealth.com
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Copyright 2013
HCPro, Inc., 75 Sylvan Street, Danvers MA 01923
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This email message and any accompanying data or files is confidential and may contain privileged information intended only for the named recipient(s). If you are not the intended recipient(s), you are hereby notified that the dissemination, distribution, and or copying of this message is strictly prohibited. If you receive this message in error, or are not the named recipient(s), please notify the sender at the email address above, delete this email from your computer, and destroy any copies in any form immediately. Receipt by anyone other than the named recipient(s) is not a waiver of any attorney-client, work product, or other applicable privilege.
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Copyright 2013
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Copyright 2013
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CONFIDENTIALITY NOTICE:
This email message and any accompanying data or files is confidential and may contain privileged information intended only for the named recipient(s). If you are not the intended recipient(s), you are hereby notified that the dissemination, distribution, and or copying of this message is strictly prohibited. If you receive this message in error, or are not the named recipient(s), please notify the sender at the email address above, delete this email from your computer, and destroy any copies in any form immediately. Receipt by anyone other than the named recipient(s) is not a waiver of any attorney-client, work product, or other applicable privilege.
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Copyright 2013
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Confidentiality Notice: This e-mail message, including any attachments, is for the sole use of the intended recipient(s) and may contain confidential and privileged information. Any unauthorized review, use, disclosure or distribution is prohibited. If you are not the intended recipient, please contact the sender by reply e-mail and destroy all copies of the original message.
Comments
This is a policy I wrote for my team’s CDI practice – you will not find this in Coding Clinic. Although, I cited relevant portions of Coding Clinic.
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: 415.412.9421
evanspx@sutterhealth.org