RSV Bronchiolitis

arsusott@msn.com

Any Pediatric Coders/CDI want to help me with this one. It is RSV Bronchiolitis season at our hospital and we have a question about the kids who come in with respiratory distress after study they are diagnosed with rsv bronchiolitis. A. Do we query for acute respiratory distress? Or do we consider the respiratory distress an integral part of the rsv bronchiolits and not even code it. (CC 91 2 Q uses copd as an example that acute respiratory distress is integral to copd) or B. Do we query every time pt comes in with respiratory distress for the acuity? C. If we get acute respiratory distress (518.82) which is not a "symptom" code and plain respiratory distress (786.09) is a symptom code... do we assume we can pick either as the pdx (rsv bronch or acute respiratory distress) depending on resources used (However, I think they would probably use the same resources to treat both.)?

We are using the APR-DRG for most of these kids and the acute respiratory distress moves the soi up and I am struggling a bit with this because I think the respiratory distress is part of the bronchiolitis. Any thoughts would be greatly appreciated. Thank you!

cmclose@saintfrancis.com

Acute resp distress is integral to RSV bronchiolitis. RSV bronchiolitis
is the cause of the ac. resp distress so your principle is RSV
bronchiolitis (lower DRG/RW) and our coders do not code the acute resp
distress with this. I will query for the acuity of resp distress (even
if it is integral to the condition) for severity of illness if I have
time to do so.
That is how my consulting company instructed me. Acute resp distress is
a symptom so don't use it as principle if there is a known/suspected
condition causing this~ query the doctor.
Hope this helps.
Claudine Hutchinson RN
Clinical Documentation Improvement Specialist
Children's Hospital at Saint Francis
Email: chutchinson@saintfrancis.com
Office: (918) 502-6603
Pager: 98-1001