Chronic Respiratory Failure

STrapuzzanoSTrapuzzano
in Clinical & Coding
I need clarification on chronic  respiratory  failure. If a patient has been diagnosed with chronic respiratory failure and provider documents oxygen dependent but also states uses PRN or at night only...This would not be considered chronic real failure..correct? I understand it has to be continuous or dependent. Just wanted to make sure! I am seeing this a lot in the outpatient setting. 

Comments

  • jillian.bisbejillian.bisbe

    I posted this question back in March. The general consensus was O2 24/7. If you go back a few pages on the forum it will take you to the discussion :) 

  • STrapuzzanoSTrapuzzano
    This is in regards to outpatient. I did read prior posts but  I questioned  providers documenting chronic resp. failure with or without hypoxia when the o2 is noted as supplemental or prn. This is what I was told: You can still have chronic respiratory failure even if your baseline Sp02 is above 91% and without continuous o2 whether supplemental or dependent. 
  • evanspx@sutterhealth.orgevanspx@sutterhealth.org

    I prefer to cite definitive resources, when I can.   I don't have one for this topic. But, in conversation with our Pulmonologist and Respiratory Team, we were advised that CMS requires 24 hours oxygen therapy.   Some of the diagnostic criteria may include elevated bicarbonate on metabolic panel and or 'elevated' pCO2.  Sorry I can't be more definitive, and obviously this 'needs some work'.  Baseline p02 our RT team cited was < 60 on RA.    These are from my working notes.  Can't cite a web page.


    Paul Evans, RHIA, CCDS

  • STrapuzzanoSTrapuzzano
    Thank you Paul! I agree with you. I am going to pass this along. I am sure this be a great discussion among the providers!
  • evanspx@sutterhealth.orgevanspx@sutterhealth.org

     Actually, I just had a conversation with Allen Frady, and referred me to some excellent resources, as below:

    Dr. Pinsons example of chronic (hypercapnic) respiratory failure (no acute) has the CO2 at 52 and he specifically calls out that it cannot be acute with a normal PH.

     

     

    https://www.kireports.org/article/S2468-0249(18)30128-1/pdf

     

    https://acphospitalist.org/archives/2011/03/coding.htm

     

    http://www.hcpro.com/content/299600.pdf

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