intubated for airway protection

katysuegood@gmail.com

What is your interpretation of the guidance (CCQ32012p21) not to code mechanical ventilation for airway protection?

I have a patient that came in with a brainstem CVA with an intial GCS of 9. He was intubated at the prior hospital. The H&P diagnoses Acute respiratory failure but then states that he was 'intubated for airway protection'. This is also in the progress note. He was extubated the following day, stated as 'compassionate extubation'. Immediately after extubation RA sats were in the 60's-70's. He dies approx. 14 hrs after extubation.

Discharge Summary states:


ADMITTING DIAGNOSES:

1. Coma secondary to mid brain embolic cerebrovascular accident.

2. Acute respiratory failure requiring mechanical ventilation.

3. Shock.

4. Prior cerebrovascular accidents.

HISTORY: This is a 70-year-old male who was found unresponsive at home. With arrival of EMS,

the patient had ACLS performed at the home and was taken to Page Hospital. He was found to be

in shock and intubated and transferred here for continued care.


Should Mechanical ventilation be coded 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

katysuegood@gmail.com

Because the coder is not coding it ;-)

I would code it, I just want to make sure I am right before I take it up with him as he specifically stated he did not code it because of the documentation of it being for ‘airway protection’

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.org

Hi, Katy

I’d feel comfortable coding the MV as the clinical indication and documentation supports it..(I think the context whereby a pt is placed on vent for airway protection (and respiratory failure is not present) in setting of something such as seizure is different than situation you described in which ARF is stated.


That is my opinion…hope it helps,

PE

Paul Evans, RHIA, CCS, CCS-P, CCDS

Manager, Regional Clinical Documentation
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@01D15D06.C20EECC0]

katysuegood@gmail.com

I agree with what you are suggesting Dr. Gold. The additional complexity here is that this patient was a transfer. So we don’t know if there were clinical indicators of ARF prior to intubation. But I do know that once we took him off the vent, for the rest of his life (12-14hrs), his RA sats were in the 60-70's (no history of respiratory compromise). My assumption is that he was intubated for protection only, for transfer. But that as his condition progressed, his resp drive was impacted and he was unable adequately oxygenate without support at some point between intubation and extubation. If he wasn’t on comfort care at that point, we would have been aggressively treating his respiratory status. I agree that a query is probably the best route regardless. Unfortunately, this is a retro review of a mortality chart and the CDI did not query. It will not impact the record financially or SOI/ROM as it is already maxed, I just like to engage in these discussions with coding whenever I see opportunity because it may come up on another chart in the future for this coder where it would have impact.

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

vanessa.falkoff

Thanks Katy I am glad you did

Vanessa Falkoff RN
Clinical Documentation Improvement Coordinator

University Medical Center of Southern Nevada
1800 W Charleston Blvd
Las Vegas, NV
vanessa.falkoff@umcsn.com
office 702-383-7322

Compassion * Accountability * Respect * Integrity