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?


  • 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.  
  • I agree with paul- many people state the etiology must be the pdx. but if you look in the code book- there is no "code first the etiology" note listed below acute respiratory failure. Over the years AHA Coding Clinic has evolved and the latest if you search states that it will depend upon the circumstances of the admission. Without examining the entire record, i can definitively saw which would be sequenced first- but will say as a nurse- acute respiratory failure will ALWAYS buy you an inpatient admission. COPD exacerbation is not as definite.  the patient may be able to be treated in outpatient setting.
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