RDS and Respiratory failure in the NICU

Hi all-

I'm having some issues translating clinical into coding.  My neonatologists are telling me that their preemies are having Respiratory Distress Syndrome (surfactant issue) and that is leading to Respiratory Failure of the Newborn.  I thought that I heard in an ACDIS webinar that they can both be coded, as long as only one of them (RDS) is POA.  Coding is refusing to code the failure.  This is decreasing the ROM.  Can anyone speak to this?

Thanks in advance,




  • Hi Kara,

    RDS is a form of respiratory failure and it would only be appropriate to code one or the other on admission. However, if the baby had RDS at birth, received surfactant, possibly required mechanical ventilation and recovered but 30 days into the stay developed severe sepsis with acute respiratory failure...that's a different ballgame and I believe it should be coded. The acute respiratory failure of the newborn would be POA N and the RDS Y.

    Early guidance on ICD-10 Excludes one notes stated that the conditions were never to be coded together but the Official Guidelines have since been updated to basically state an exception to the excludes 1 definition is the circumstance when the two conditions are unrelated to each other. If the relationship is not clear then query the Provider.

    I would not code them both at the beginning of the stay in combination...this is similar to not coding ARDS and acute respiratory failure as ARDS is the most severe type of acute respiratory failure.

    I hope this helps. If you have any specific scenarios I can help you with please don't hesitate to reach out to me via email jwmorris@health.southalabama.edu


  • I was wondering why if ARDS is the more severe type of acute respiratory failure, why does it code a lower soi/rom than acute respiratory failure?  Same for RDS vs Acute resp failure of newborn.  The respiratory failure codes much higher than the RDS. 
  • Hi Kara,

    Your coding department is correct for not coding both. They only way I capture ‘Respiratory Failure’  with ‘RDS’ in the neonates is when it’s cleary defined the ‘Respiratory Failure’ is due to  another medical conditions versus the underlying RDS. Pay close attention to the oxygen support and gestational age you might have a query opportunity for BPD. 
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