Does a patient have to be on 24/7 continuous oxygen in order to be queried for Chronic resp. failure

Can a patient have chronic respiratory failure and be treated with less than 24/7 continuous oxygen therapy? Can a patient be in chronic respiratory failure and be treated with steroids and nebs alone? In reading 3M CDI system reference it states the following "regardless of the amount of time on oxygen each day"

3M Coding reference-CDI system reference

Query Opportunity

  • Review the medical record documentation for the condition that requires the oxygen dependence, e.g., COPD, emphysema, acute-on-chronic systolic heart failure, chronic systolic heart failure, chronic respiratory failure. Query for clarification if condition is not documented.

Clinical Documentation Concepts

  • Dependence on supplemental oxygen indicates the patient is on long term oxygen therapy. This can be reported regardless of the amount of time on oxygen each day (e.g., patient uses oxygen only at night). Additionally, although the patient might not be dependent on admission, review the record for need for home O2 at time of discharge.
Thank you

Comments

  • Looking at the reference below - I always read this as you can report "dependence on supplemental oxygen" regardless of the amount of time per day the patient is on oxygen.  I did not think it implied to chronic respiratory failure, as the this reference is not located under "unspecified chronic respiratory failure".

    Clinical Documentation Concepts 

    Dependence on supplemental oxygen indicates the patient is on long term oxygen therapy. This can be reported regardless of the amount of time on oxygen each day (e.g., patient uses oxygen only at night). Additionally, although the patient might not be dependent on admission, review the record for need for home O2 at time of discharge.


    Thank you,

    Michael Daisey

  • edited April 15
    Good point, Michael, because “dependence’ on oxygen is not documentation of ‘chronic respiratory failure’ nor does it code to ‘chronic respiratory failure’, although it could be clinical support for same.
  • Per the 2019 Pocket Guide, pg 194, it is indicated that "Dependence on continuous home O2 (24 hours a day) is a reliable indicator of chronic hypoxemic respiratory failure. Intermittent use for exertional nocturnal desaturation is not." Based on that, when the patient is not on O2 24/7, I understand the clinical concept discussing "regardless of the amount of time" to support adding code Z99.81, but not for use in a chronic respiratory failure query.
  • My statement may have been confusing?  I believe that ‘dependence on continuous home O2’ is one indicator of chronic respiratory failure.  Intermittent use is not.


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