Expected post-operative respiratory failure

I recently took on a new assignment reviewing ICU/progressive care charts. I see a lot of documentation of "Expected post-op respiratory failure" or "Expected AHRF" on post op or CABG patients who were successfully weaned within the 6 hours post-op. Any tips on how I should write a clarification?


  • This is a big topic of confusion. But it's my understanding that documentation of "Expected" diagnosis cannot be captured in Coding. That Respiratory Failure was "Expected" as part of the normal course for the patient, so no further clarification is needed. It's a little frustrating because even the documentation of "Expected" Acute Blood Loss Anemia cannot even be captured, and sometimes this leaves a CABG patient without a single CC/MCC.

    At our facility, if the patient is extubated within 6 hours, we document "Acute Respiratory Insufficiency," while the patient is Intubated, and still waking up from sedation/and anesthesia.

  • When we query in this scenario, we give query options allowing physician to validate or rule out the respiratory failure. Options such as

    • Postoperative respiratory failure is valid as evidenced by _______ (please identify)
    • Mechanical ventilation as expected following surgery, no respiratory failure
    • Other

  • Other possibilities:

    *Postoperative ventilation normal perioperative CABG course, no extra monitoring or treatment provided.

    *Acute pulmonary insufficiency still requiring HFNC.


  • AHA CC 3Q 2008 pg 15 and 3Q 2004 pg 4

    “…Coding Clinic states:   “If in the physician’s clinical judgment, surgery results in an expected amount of blood loss and the physician does not describe the patient as having anemia or a complication of surgery, do not assign a code for the blood loss.” (AHA CC 3Q 2004 pg 4)

    My interpretation: If the ‘expected’ condition is stated as a diagnosis and meets clinical validation and coding guidelines for that condition, then it s/b coded, it just would not be coded as a complication, as it is not being stated as a complication. For ‘postop respiratory failure’ the problem is usually that it does not meet clinical validation as failure, more likely respiratory insufficiency or distress…so clarify the nature of the respiratory issue and if it meets coding guidance, then it s/b coded, but not as a complication if not stated as such.

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