Asthma w/ Acute Resp Failure vs Acute Resp Failure w/ Asthma
Hi folks, this is a common clinical conundrum and one that I think we have to address. It is prevalent in the Pediatric world but also occurs in the adult world as well (change 'asthma' to 'COPD' for a similar concept)
What causes the admission to the hospital? is it the exacerbation of the chronic condition (asthma, COPD) or is it the Respiratory Failure?
Clinically, can (should) the exacerbation of the chronic condition be treated in the outpatient setting (ER/OBS) with nebulizers, inhalers and O2? Without the Acute Respiratory Failure, would the patient even be admitted to the inpatient hospital setting?
The providers are co-equally treating the Acute Respiratory failure and the Asthma, and coders are concretely interpreting the coding guidelines that in that case they can choose either the Acute Respiratory Failure or Asthma as the principal diagnosis for DRG "optimization". This mindset misses the clinical reality that Asthma or COPD exacerbation should be treated in the outpatient setting, and the only reason the inpatient admission is occurring is because of the Acute Respiratory Failure. I think that is the crux of the common disagreements in this case between coders and CDI.
Optimization means nothing to a case that is denied because it is clinically indefensible.
I know that we have lots of CDI Specialists that grew up in coding whereas I grew up in IT and Nursing. Is there a good argument from coding that can stand up to the payer audits when the coders insist on coding Asthma as the principal diagnosis and Acute Respiratory Failure as the secondary diagnosis?
Looking forward to seeing many of you next week!
Mark
What causes the admission to the hospital? is it the exacerbation of the chronic condition (asthma, COPD) or is it the Respiratory Failure?
Clinically, can (should) the exacerbation of the chronic condition be treated in the outpatient setting (ER/OBS) with nebulizers, inhalers and O2? Without the Acute Respiratory Failure, would the patient even be admitted to the inpatient hospital setting?
The providers are co-equally treating the Acute Respiratory failure and the Asthma, and coders are concretely interpreting the coding guidelines that in that case they can choose either the Acute Respiratory Failure or Asthma as the principal diagnosis for DRG "optimization". This mindset misses the clinical reality that Asthma or COPD exacerbation should be treated in the outpatient setting, and the only reason the inpatient admission is occurring is because of the Acute Respiratory Failure. I think that is the crux of the common disagreements in this case between coders and CDI.
Optimization means nothing to a case that is denied because it is clinically indefensible.
I know that we have lots of CDI Specialists that grew up in coding whereas I grew up in IT and Nursing. Is there a good argument from coding that can stand up to the payer audits when the coders insist on coding Asthma as the principal diagnosis and Acute Respiratory Failure as the secondary diagnosis?
Looking forward to seeing many of you next week!
Mark
Comments
I am finding that the providers often use the terms "acute COPD exacerbation" and :Acute hypoxic respiratory failure" interchangeably. This creates the dilemma of which one is the principle diagnosis, the diagnosis occasioning the admit. Any comments?
Hi Mark,
For our Peds that are admitted with an acute exacerbation of their asthma who meet criteria for acute respiratory failure and that diagnosis is documented, whether initially by the MD or via query, we almost always sequence the acute respiratory failure as PDX.
Jeff