Chronic Respiratory Failure
When I started in CDI I was taught that if a patient with COPD is on Home oxygen, it is appropriate to query for Chronic Respiratory Failure. I am wondering how many of you query for that and if so, how do you go about querying for it? I am always concerned that my query is leading and introducing new information since the doctor is not documenting respiratory failure prior to a query.
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Diagnostic criteria:
-hypoxemia of variable severity (often with baseline p02 <60 on RA)
-elevated pC02
-elevated bicarb level
-normal pH
It also has:
Treatment:
The most important indicator of chronic resp failure is dependence on continuous home 02. Patients who qualify for home 02 have chronic resp failure and a baseline p02 <60 (Sp02 <91%).
I think if the patient has a chronic lung disease severe enough to require continuous home oxygen that it is not leading. The docs do not think of this diagnosis unless it becomes acute. This is probably something we could all query for more frequently. It will be interesting to see what others have to say.
I really need to get a pocket guide... I didn't have ABG for this particular stay, but it is documented that the pt is on up to 5L of O2 at home, so that should cover it
Jackie Touch
P.S. I think I will invest in the 2017 Pocket Guide too!
I try to include the Home O2 evaluation when I query for Chronic Respiratory Failure. It is not always done, but the documentation of the patient's Room Air sat and level of oxygen needed to maintain a sat of 90% is very helpful.
Can someone please share their query? We are having a difficulty time here. We are disagreeing as to how to word the query and when we do send it the response from MD is usually acute on chronic resp failure (it is one of the choices) which isn't clinically supported. I was asked to prepare a new query template and need you help. Here is our query:
We need your assistance in determining the correct diagnosis for this patient. There is documentation from the record that this patient has a history of COPD and is on home oxygen @ ______L. Please provide the appropriate diagnosis that utilizes the use of continue oxygen therapy. Acute on Chronic Respiratory FailureAcute Respiratory Failure Chronic Respiratory Failure Hypoxemia Other - please specify Unable to determine This query will become part of the patient's medical record.Jackie Touch
There is a number of different criteria out there. often providers describe lung disease such as the GOLD classification grading. Teach providers to use the term chronic respiratory failure instead of 'end stage lung disease'. This is a diagnosis that is often missed, and is worth capturing.
In reading the above, I am left with this question...can a patient have chronic respiratory failure and be treated with less than 24/7 continuous oxygen therapy? Can a patient be in chronic respiratory failure and be treated with steroids and nebs alone? In reading 3M CDI system reference it states the following "regardless of the amount of time on oxygen each day"
3M Coding reference-CDI system reference
Query Opportunity
Clinical Documentation Concepts
- Dependence on supplemental oxygen indicates the patient is on long term oxygen therapy. This can be reported regardless of the amount of time on oxygen each day (e.g., patient uses oxygen only at night). Additionally, although the patient might not be dependent on admission, review the record for need for home O2 at time of discharge.
Thank you