Acute Respiratory Failure query

Snook@fmchealth.orgSnook@fmchealth.org
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I am revising out Acute Respiratory Failure query using the latest Coding Clinic information and our own recently developed organizational criteria. Should I query to see if the respiratory failure is due to hypoxia or hypercarbia in addition?

Mary L. Snook RN-BC
Clinical Documentation Improvement Specialist
Fairfield Medical Center
740-689-4443



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I am revising ou=
t Acute Respiratory Failure query using the latest Coding Clinic informatio=
n and our own recently developed organizational criteria. Should I query to=
see if the respiratory failure is due to hypoxia or hypercarbia in additio=
n?

 

Mary L. Snook RN-BC

Clinical Docum=
entation Improvement Specialist

Fairfiel=
d Medical Center

740-689-4443=

 

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Fairfield Medical Center
People you know. Care you trust.

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t;Confidentiality Notice: This email 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 dis=
tribution is prohibited. If you are not the intended recipient, please cont=
act the sender by reply e-mail and destroy all copies of the original messa=
ge."

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Comments

  • deanne_wilkdeanne_wilk
    Mary can you share what that will look like then?


    Deanne Wilk, BSN, RN, CCDS, CCS
    AHIMA approved ICD-10-CM/PCS Trainer

    Clinical Documentation Improvement and Inpatient Coding Manager
    HIMS Department
    Good Samaritan Health System
    4th & Walnut Sts
    Lebanon, PA 17042
    dwilk@gshleb.org

    Phone: 717-270-7582
    Cell: 717-580-1436



    From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
    Sent: Monday, June 22, 2015 7:41 AM
    To: Wilk, Deanne L.
    Subject: [cdi_talk] Acute Respiratory Failure query

    I am revising out Acute Respiratory Failure query using the latest Coding Clinic information and our own recently developed organizational criteria. Should I query to see if the respiratory failure is due to hypoxia or hypercarbia in addition?

    Mary L. Snook RN-BC
    Clinical Documentation Improvement Specialist
    Fairfield Medical Center
    740-689-4443





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    Fairfield Medical Center
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  • gwojogwojo
    edited April 2016
    I believe that information will be required in 10.


  • katysuegood@gmail.comkatysuegood@gmail.com
    edited April 2016
    Yes, I think that if you are revising your Resp failure query, these options should be included. We have updated ours to reflect this additional specificity. That being said, I would not say this is ‘required’ with I-10. This specificity is ‘available’ in I-10. We want to encourage our providers to begin to document this specificity but will not be querying for it if they document Acute resp failure but do not specify hypoxic vs hypercarbic. Other facilities may choose to respond differently but this is our approach. Unless there is a recent change I am unaware of, All forms of Acute resp failure will continue to be an MCC in I-10 so I do not see this as a critical issue at this point. Now if the CC/MCC designation changed…..

    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

  • catladyrncatladyrn
    We have begun to query for hypoxia/hypercapnia for our respiratory failure patients. Although a large number of diagnoses lacking ICD-10 specificity are not changing as CC/MCCs right now, it is our expectation that diagnoses that fail to meet ICD-10 specificity requirements may eventually be downgraded from the CC/MCC list or denied outright.

    Renee

    Linda Renee Brown, RN, MA, CCDS, CCS, CDIP
    Director, Clinical Documentation
    Tanner Health System
  • katysuegood@gmail.comkatysuegood@gmail.com
    edited April 2016
    I completely agree that this may someday change Renee, similar to Renal failure. However, this is just a frustration of mine because it was so often used during the I-10 'frenzy' a couple years ago as an example of why I-10 would change everything and have significant revenue impact. I had more than one consulting company use this as an example of DRG revenue impact, when in fact there is no risk associated with this I-10 code expansion from a CC/MCC standpoint. Even unspecified resp failure (not specified as acute) continues to be an MCC.
    I think there is reason to encourage this documentation (as you have stated) but I just don’t want people to get the idea that this is 'required' is the sense that without it revenue will decrease or that there is no unspecified code. I am likely being nit-picky :). We added this terminology to our ARF query almost two years ago. So when we do query for ARF our providers are getting this reinforcement. With this intervention alone we now routinely see this documentation now without additional prompting. It has been our decision not to query for this information alone in an effort not to overwhelm our MD's with queries that do not have significant impact on the record in one way or another. This is consistent with our general decision to query. We currently do not query for all code specificity that is available in I-9 and we do not intend on doing this in I-10. However, I realize that there are programs that have alternate takes on this issue. I think either approach is fine as long as we are all aware of the reasons for doing it.

    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

  • evanspx@sutterhealth.orgevanspx@sutterhealth.org
    edited April 2016
    I agree w/ Katy...No doubt the changes w/ I-10 are vast, and, just as with I-9, some of the changes are very impactful for either a Quality Metric or proper reimbursement, but others are not. We need to make that distinction and apply the Pareto Logic to our work.



    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



  • catladyrncatladyrn
    We have done an analysis of our top DRGs by volume and are focusing on the major diagnoses associated with them. Acute respiratory failure is a high profile diagnosis that we have chosen to cover. We know we can't and shouldn't query every single diagnosis that isn't I-10 compliant, but at the same time we don't want to give CMS or commercial payors ammunition by ignoring high profile, high reimbursement diagnoses that have high potential for downgrade. I keep telling my team that if they can get laterality across, they've won 40% of the entire battle.


    Renee

    Linda Renee Brown, RN, MA, CCDS, CCS, CDIP
    Director, Clinical Documentation
    Tanner Health System
  • evanspx@sutterhealth.orgevanspx@sutterhealth.org
    edited April 2016
    I agree w/ Renee that it is wise to query for as much specificity as possible, and for all of the reasons she stated so well.

    But, I also do think that some consulting firms have 'churned' the waters a bit by stating that some of the particular specificity will be 'required' by I-10...this is not always an accurate statement of fact. Greater specificity may be AVAIALBLE, but this does not mean it may always be REQUIRED for compliant billing.



    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




  • Snook@fmchealth.orgSnook@fmchealth.org
    edited April 2016
    Sorry it took so long to get back to you. I had to complete a few changes to the query. I get input from my CDI partner and our Coding Supervisor. We just need to add our header at the top of the form and it is ready.

    Mary L. Snook RN-BC
    Clinical Documentation Improvement Specialist
    Fairfield Medical Center
    740-689-4443



    From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
    Sent: Monday, June 22, 2015 10:32 AM
    To: Mary Snook
    Subject: RE:[cdi_talk] Acute Respiratory Failure query

    Mary can you share what that will look like then?


    Deanne Wilk, BSN, RN, CCDS, CCS
    AHIMA approved ICD-10-CM/PCS Trainer

    Clinical Documentation Improvement and Inpatient Coding Manager
    HIMS Department
    Good Samaritan Health System
    4th & Walnut Sts
    Lebanon, PA 17042
    dwilk@gshleb.org

    Phone: 717-270-7582
    Cell: 717-580-1436



  • pscheiderichpscheiderich
    edited April 2016
    Thanks for sharing Mary.


    Paula Scheiderich, RHIT
    Clinical Documentation Specialist
    Oneida Healthcare
    315 363-6000 Ext. 1084
    pscheiderich@oneidahealthcare.org


  • Snook@fmchealth.orgSnook@fmchealth.org
    edited April 2016
    You are welcome. The query was easy. Pinning down our Pulmonologists regarding the criteria was the hard part.

    From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
    Sent: Tuesday, June 30, 2015 1:37 PM
    To: Mary Snook
    Subject: RE:[cdi_talk] Acute Respiratory Failure query

    Thanks for sharing Mary.


    Paula Scheiderich, RHIT
    Clinical Documentation Specialist
    Oneida Healthcare
    315 363-6000 Ext. 1084
    pscheiderich@oneidahealthcare.org


  • pscheiderichpscheiderich
    edited April 2016
    Your lucky to have a Pulmonologist, we do not have one here.

  • Snook@fmchealth.orgSnook@fmchealth.org
    edited April 2016
    Yes we have actually three of them! They are all brilliant and we have Care rounds everyday in ICU with one of them. I attend the rounds and ask CDI questions which they are more than willing to answer and document. I am a lucky girl. They manage most of our ICU medical patients.

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