acute hypoxemic respiratory failure
I just had a conversation with our hospitalist who is documenting ac respiratory failure hypoxemic. He is stating that you only need a low pulse ox to qualify for this. Does anyone agree with this? I was always taught you needed at least 2 clinical indicators. HELP
Tracy Peyton RN CCDS
Tracy Peyton RN CCDS
Comments
cari
Best Regards,
Cari Merlina RN, BSN
Clinical Documentation Improvement Specialist
Revenue Cycle
Yampa Valley Medical Center
p.970.871.2425
f.970.875.2796
Cari.merlina@yvmc.org
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
-----Original Message-----
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Friday, February 12, 2016 9:41 AM
To: Evans, Paul
Subject: RE: [cdi_talk] acute hypoxemic respiratory failure
Hi! It's like pulling teeth for me to get the dx! You can refer to that ACP paper, and I have more sources that correlate Sp02 to Pao2, although we know this is not always accurate (COPD, hypoperfusion of finger/toe/ear, fingernail polish:) lol cari Best Regards,
Cari Merlina RN, BSN
Clinical Documentation Improvement Specialist Revenue Cycle Yampa Valley Medical Center
p.970.871.2425
f.970.875.2796
Cari.merlina@yvmc.org
-----Original Message-----
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Friday, February 12, 2016 10:25 AM
To: Merlina, Cari
Subject: [cdi_talk] acute hypoxemic respiratory failure
I just had a conversation with our hospitalist who is documenting ac respiratory failure hypoxemic. He is stating that you only need a low pulse ox to qualify for this. Does anyone agree with this? I was always taught you needed at least 2 clinical indicators. HELP
Tracy Peyton RN CCDS
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Copyright 2013
HCPro, Inc., 75 Sylvan Street, Danvers MA 01923
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Copyright 2013
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Tracy M Peyton RN, CCDS
Bradford Regional Medical Center
Upper Allegany Health Systems
116 Interstate Parkway
Bradford, PA 16701
________________________________________
From: CDI Talk [cdi_talk@hcprotalk.com]
Sent: Friday, February 12, 2016 12:45 PM
To: Peyton, Tracy M
Subject: RE: [cdi_talk] acute hypoxemic respiratory failure
Dr. Pinson published an excellent and comprehensive article in the ACDIS journal...you can go to the ACDIS website and the topic of each issue will be listed, enabling you to find that article, which is one of the most helpful and comprehensive articles I have read on that topic.
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
-----Original Message-----
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Friday, February 12, 2016 9:41 AM
To: Evans, Paul
Subject: RE: [cdi_talk] acute hypoxemic respiratory failure
Hi! It's like pulling teeth for me to get the dx! You can refer to that ACP paper, and I have more sources that correlate Sp02 to Pao2, although we know this is not always accurate (COPD, hypoperfusion of finger/toe/ear, fingernail polish:) lol cari Best Regards,
Cari Merlina RN, BSN
Clinical Documentation Improvement Specialist Revenue Cycle Yampa Valley Medical Center
p.970.871.2425
f.970.875.2796
Cari.merlina@yvmc.org
-----Original Message-----
From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Friday, February 12, 2016 10:25 AM
To: Merlina, Cari
Subject: [cdi_talk] acute hypoxemic respiratory failure
I just had a conversation with our hospitalist who is documenting ac respiratory failure hypoxemic. He is stating that you only need a low pulse ox to qualify for this. Does anyone agree with this? I was always taught you needed at least 2 clinical indicators. HELP
Tracy Peyton RN CCDS
---
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You are receiving this message as a member of CDI Talk as: Cari.Merlina@yvmc.org If you would like to be removed from CDI Talk, please send a blank email to leave-cdi_talk-20336902.a0626d9483f8984bb855a807cafad7dc@hcprotalk.com
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Copyright 2013
HCPro, Inc., 75 Sylvan Street, Danvers MA 01923
The information contained in or attached to this electronic message is privileged and confidential, intended only for the use of the individual(s) named above. If the reader of this message is not the intended recipient, or the employee or agent responsible to deliver it to the intended recipient, you are hereby notified that any dissemination, distribution, or copying of this communication is strictly prohibited. If you have received this communication in error, please inform the sender immediately and remove any record of this message.
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Copyright 2013
HCPro, Inc., 75 Sylvan Street, Danvers MA 01923
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Copyright 2013
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Confidentiality Notice: The information contained in this message may be legally privileged and confidential information intended only for the use of the individual or entity named above. If the reader of this message is not the intended recipient, or the employee or agent responsible to deliver it to the intended recipient, you are hereby notified that any release, dissemination, distribution, or copying of this communication is strictly prohibited. If you have received this communication in error please notify the author immediately by replying to this message and deleting the original message. Thank you.
Tracy M Peyton RN, CCDS
Bradford Regional Medical Center
Upper Allegany Health Systems
116 Interstate Parkway
Bradford, PA 16701
________________________________________
From: CDI Talk [cdi_talk@hcprotalk.com]
Sent: Monday, February 15, 2016 9:00 AM
To: Peyton, Tracy M
Subject: re:[cdi_talk] acute hypoxemic respiratory failure
Tracy, that myth came from a Coding Clinic which described criteria that represent respiratory failure. At that time, the folks who answered the questions didn't yet know about hypoxemic (hypoxic) or hypercapnic respiratory failure. All respiratory failure need clinical circumstances to consider the term respiratory failure. You never go for lab results alone.
Hypercapnic respiratory failure usually needs two numbers - the patient's pCO2 which will tell if the patient is hypercapnic or not and does not differentiate between acute or chronic - plus a pH under 7.30 which throws it into the acute category.
Hypoxemic respiratory failure usually uses a pO2 under 60 (some say 55) or a pulse oximeter reading under 91% in spite of 60% oxygen being administered. And you cannot tell without looking at the patient if it's acute or chronic unless you have previous levels of blood oxygenation to be able to demonstrate an acute difference.
http://emedicine.medscape.com/article/167981-overview
Dr. G.
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Confidentiality Notice: The information contained in this message may be legally privileged and confidential information intended only for the use of the individual or entity named above. If the reader of this message is not the intended recipient, or the employee or agent responsible to deliver it to the intended recipient, you are hereby notified that any release, dissemination, distribution, or copying of this communication is strictly prohibited. If you have received this communication in error please notify the author immediately by replying to this message and deleting the original message. Thank you.
Please don't leave us hanging, (smile)--what about clinical indicators for acute post-op pulmonary insufficiency, and if there is a non-procedural pulmonary insufficiency, please give us an update. Yes, you've advised against the terminology on the I-9 environment, but it appears the acute post-op plum insuff is Not a PSI, whereas post-op resp failure Is a PSI.
Our doctors ask us for differentiation, and I'm left saying "it doesn't meet acute postop respiratory failure," but is there an ongoing pulmonary pathophysiology (hypoventilation, edema, parenchymal disorder), or is this due to pathology in the patient's history associated w the Mech ventilation greater than 48 hours postop?
Thank you for your relentless support of an accurate clinical record.
Melanie
Sent from my iPhone
Please excuse spelling and grammatical errors.
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