COVID-19 & ARDS vs. Acute Respiratory Failure
Good Morning!
We have a question regarding ARDS (J80) vs. Acute Respiratory Failure (J96) and which to code when both are documented. The J96 category (Resp fail) has an Excludes1 for J80 ARDS, so you cannot code both unless there is documentation of the ARDS being related to something other than the resp failure. Clinically, since ARDS is a more severe/specific diagnosis than RespFail and if both are documented, it would make sense to code J80.
3M also said this in this webinar around 17 min in. However, when you put each of them in the encoder (attached word file), J80 has a lower SOI/ROM. Prior to COVID-19, the coders would just code J96, if both were documented, but we now moved to coding J80 for COVID-19 patients. What are your thoughts/rationale?
Comments
Hi Sarah,
Our Physician Advisor did a COVID 19 inservice for us yesterday and said that if the patient was in ICU and/or on a vent, that ARDS was more appropriate. Her rationale matches yours. I am not sure why it is not higher weighted!
Maybe someone will know why is it weighted the way that it is.
Thanks,
Laura
We have a related question. If the patient comes in with acute respiratory failure that progresses to ARDS would you code the ARDS as present on admission or not present on admission?
See AHA CC 4Q 2020 pg 97, assign POA of YES to ARDS when it progresses from ARF present on admission.