Acute Pulmonary Insufficiency
When discussing persistence of greater than expected oxygenation problems beyond 48 hours in a post op extubated patient I inquire about whether or not the diagnosis of Acute Pulmonary Insufficiency is applicable with physicians and they simply state they have never heard of the term and or have never seen the definition of it. Physician’s often use the term ‘Insufficiency’ loosely in there documentation except in the case of Acute Pulmonary Insufficiency. We often see documentation of adrenal insufficiency, arterial insufficiency, acute coronary insufficiency, pancreatic insufficiency, acute renal insufficiency, acute respiratory insufficiency, vertebro- basilar insufficiency etc.
Let us split the hairs between failure and insufficiency. Merriam Webster dictionary defines failure as “a state of inability to perform a normal function” where the word perform is defined as: to carry out an action. In practice Respiratory Failure is defined as: the respiratory system fails in one or both of its gas exchange functions: oxygenation and carbon dioxide elimination. In practice, respiratory failure is defined as a P/F ratio < 300, a PaO2 value of less than 60 mm Hg while breathing room air or a PaCO2 of more than 50 mm Hg.
Respiratory is defined as: of or relating to respiration which is movement of gases (as oxygen and carbon dioxide) into and out of the lungs.
Merriam defines insufficiency as” inability of an organ or body part to function normally” where function is defined as any group related actions contributing to a larger action. Pulmonary is defined as: of, relating to, affecting, or occurring in the lung.
So what could cause the lungs not to function normally (be insufficient) in the post op patient? Why the prolonged oxygen therapy without a diagnosis? Well we all learned this stuff years ago in med school. The most common causes of course are atelectasis and lung edema. But many other issues exist as well. Reduced tidal volume of up to 50% depending the location of the incision (thorax, upper abdomen).Reduced lung expansion from post op pain, supine position, abdominal distention, sedatives and narcotics. Increased ventilation rate secondary to anxiety leads to loss of normal periodic hyperinflation. Compromised airway defenses secondary to loss of normal cough reflex, decreased ciliary activity and accumulation of secretions. Problems related to laparoscopic surgery include diaphragmatic splinting from pneumoperitoneum. Another issue is the (SIRS) systemic inflammatory state from the trauma of surgery itself in which circulating inflammatory mediators cause edema in the lung parenchyma. Variables predictive of postoperative pulmonary insufficiency include active cigarette smoking, baseline COPD, and cardiac, renal, or bleeding complications.
provided an ICD 10 CM code to capture the condition but it needs to be
documented as “Acute Pulmonary Insufficiency” for the code to be assigned.
The code for Acute Pulmonary Insufficiency was created to capture the cost of
treating those patients requiring greater than expected LOS or use of oxygen
for hypoxia post operatively. J95.1 Acute Pulmonary Insufficiency (coder will
use this code in thoracic surgery cases) J95.2 Acute Pulmonary Insufficiency
MCC (coder will use this code in non-thoracic surgery cases).
So if you’re surgical patient is not progressing as expected due to the inability of 1 or both lungs to function normally consider the diagnosis of acute pulmonary insufficiency in your documentation to explain this delay in discharge.