RESP FAILURE
I am a RN, CDIS with no coding background. Our CDI program is new. I am having issues with Resp Failure. I have been asked by our coding team why I am querying the physicians for specificity. I have been told that when a physician writes "resp failure" it automatically codes to 518.81 which is "acute resp failure." What are your thoughts? We have developed a Resp Failure query to ask a physician when he writes "chronic O2 dependent" or r"esp failure" to specify. Should we be? I am so confused. Thanks in advance for your input!
Dawn Vitalone, RN
CDI Specialist
Community Hospital
Dawn Vitalone, RN
CDI Specialist
Community Hospital
Comments
Our program is fairly new too, but from what I understand if a Doc
writes "resp failure" it does automatically default to acute respiratory
failure. When we first started our program we left a lot of queries to
get the docs to add the acute until we realized that it defaulted to
acute regardless. However, sometimes the docs will write "acute resp
insufficiency" and we will definitely query that for "acute respiratory
failure" if the 02 sats are low (usually 88% on room air or lower). As
far as "chronic o2 dependency" goes we will query that for "chronic
respiratory failure." And if it looks like there might be an
exacerbation we query for "acute on chronic respiratory failure."
Hope this helps.
Greta Goodman
Clinical Documentation Improvement Specialist
Clinical Documentation Improvement Program
Virginia Hospital Center
ggoodman@virginiahospitalcenter.com
Dawn M. Vitalone, RN
Clinical Documentation Improvement Specialist
Community Hospital
I hope it helps.
Robert
Robert S. Hodges, BSN, MSN, RN
Clinical Documentation Improvement Specialist
Aleda E. Lutz VAMC
Mail Code 136
1500 Weiss Street
Saginaw MI 48602
P: 989-497-2500 x13101
F: 989-321-4912
E: Robert.Hodges2@va.gov
"The difference between the right word and the almost right word is the difference between lightning and the lightning bug." Samuel "Mark Twain" Clemens
The other thing that jumped out at me from your post was that you need access to an encoder. You should be given the same software that your coders are using in order to see how they arrive at their codes. If you don't already have it, I strongly suggest you ask for it.
Renee
Linda Renee Brown, RN, CCRN, CCDS
Certified Clinical Documentation Specialist
Banner Good Samaritan Medical Center
Dawn M. Vitalone, RN
Clinical Documentation Improvement Specialist
Community Hospital
We have 3M HDM as our encoder and recently transitioned to an electronic
health record so I know what that process is like. I hope it goes
smoothly for you. We also use the DRG expert book. In addition we use
an ICD-9-CM for Hospitals book that you might find helpful if you don't
already have it. It's a great book to familiarize you with codes and
shows which codes have CCs, and MCCs. The book we have is printed by
INGENIX and is the standard version for hospitals.
Greta Goodman
Clinical Documentation Improvement Specialist
Clinical Documentation Improvement Program
Virginia Hospital Center
One of the hallmarks of acute respiratory failure I think about is - "what is happening without our intervention?", "is this patient in a normal state, or, do they require an immediate intervention to prevent worse - i.e. cyanosis, anoxia, cardio-pulmonary arrest". "Will their distress improve on its own, or, is their decompensation so severe that they require our intervention"? Otherwise, why are we treating it?
Mark
We use this definition:
* Acute respiratory failure - May be hypoxic or hypercapnic.
A clinically significant decrease in Pao2. (Most commonly, the critical threshold of Pao2 is considered to be 60 mm Hg, which is an anchor point in the oxyhemoglobin dissociation curve) AND/OR hypercapnia (Paco2 > 50 mmHg and pH < 7.34) reflecting either excessive CO2 production or inadequate CO2 elimination; Acute hypercapnic failure occurs only when the patient has concurrent acidemia, implying that the change in CO2 was too rapid or too extreme for renal (metabolic) compensation. The pH indicates whether the hypercarbia is acute or chronic. (Murray and Nadel's Textbook of Respiratory Medicine, 5th ed., John F. Murray, MD and Jay A. Nadel, MD, 2010; The Osler Medical Handbook, 2nd ed., Kent R. Nilsson Jr. MD, and Jonathan P. Piccini, MD, 2006)
However, I also like to compute the P/F ratio because of is its ability to predict, based on arterial pO2 measured while the patient is receiving supplemental oxygen, what the pO2 would be on room air.
The P/F ratio equals the arterial pO2 divided by the FIO2 (the fraction of inspired oxygen expressed as a decimal) the patient is receiving. It is most familiar, and commonly used, in the context of acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) where a P/F ratio
Katy Good, RN, BSN, CCDS, CCS
Clinical Documentation Program Coordinator
Flagstaff Medical Center
Kathryn.Good@nahealth.com
Cell: 928.814.9404
1. Increased work of breathing: cyanosis, use of intercostal muscles, Tripoding, tachypnea (or possibly very slow RR in event of CNS damage)
2. P/F ratio of < 300
3. Intervention: BiPAP or CPAP or NC at least 4L/min
Always complicated, lots of variation in definitions and applications and opinions.
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
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Tiffany