overdose/suicide with intubation
Just second guessing myself here. Suicide attempt comes in awake and alert 15 minutes after taking a massive dose of verapamil and was intubated and an A-line placed in ANTICIPATION of future instability. At that time the patient was not in any distress from a resp standpoint. She does later go into shock in the ED and eventually has a PEA arrest. She was resussitated but this could not be maintained and eventually they called the code.
Can I query for resp failure in this circumstance?
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
Can I query for resp failure in this circumstance?
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
Comments
o Respirations >28;
o Air hunger;
o Use of accessory muscles of respiration;
o Inability to speak in full sentences;
o Cyanosis;
o Pulse ox
-For airway protection
-For respiratory failure, please specify etiology/acuity
-Other -please specify
-Unable to determine
Anna Rozhkovskaya
Sent from my iPad
On Sep 14, 2015, at 6:36 PM, CDI Talk wrote:
How utterly sad… Yes I would query if I had other indicators for acute respiratory failure besides being placed on the vent for airway protection. These are the indicators that I typically use… If I have at least 2 present then I query.
o Respirations >28;
o Air hunger;
o Use of accessory muscles of respiration;
o Inability to speak in full sentences;
o Cyanosis;
o Pulse ox
My concern is that this will be the sole MCC if I query and the MD agrees…
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
I would code cardiac arrest which is a MCC as is cardiogenic shock. PEA = cardiac arrest.
[http://sv-3mxx-01:8080/reference2/images/blanknote.gif]
Mechanical ventilation for airway protectionairway protection
Coding Clinic, Third Quarter 2012 Page:21 Effective with discharges: September 15, 2012
Question:
A patient presents to the Emergency Department (ED) due to an overdose of Ambien and is intubated and placed on mechanical ventilation. The attending physician admits the patient to the intensive care unit (ICU) and documents that the patient was intubated for airway protection because of the drug overdose. There was no documentation of respiratory failure and the patient was weaned from the ventilator the following next day. Can the coder assume that the patient was in respiratory failure and report code 518.81, Acute respiratory failure, based on the fact that the patient was intubated and placed on mechanical ventilation for airway protection?
Answer:
Do not assign code 518.81, Acute respiratory failure, simply because the patient was intubated and received ventilatory assistance. Documentation of intubation and mechanical ventilation is not enough to support assignment of a code for respiratory failure. The condition being treated (e.g., respiratory failure) needs to be clearly documented by the provider.
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