COPD exac. versus Acute respiratory failure

We have had auditors instruct us that anytime Acute respiratory failure (without vent mgmt.) due to COPD exac is documented, the Pdx should be the COPD because the COPD exac. caused the acute respiratory failure. Note: These were inpatient admissions, not observation cases.

Any advice?

Comments

  • I would have to review each case individually; some COPD exacerbations are treated at home without any need for additional support -  the fact that the patient is seeking support and treatment is provided for the respiratory failure makes me lean toward the failure as the Principal diagnosis.     any other thoughts?

  • The thought that COPD is ‘always’ the PDX is not valid.   As stated above, one would have to review the circumstances of each admission and make a determination for each case.  There is information available with details that can be cited in AHA Coding Clinic - there are scenarios that address sequencing for ARF with certain conditions.  
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