chronic respiratory failure
I have a physician that wants a definition for chronic respiratory failure. I have queried him for this in instances for end stage copd patients on continuous home O2. I was curious if anyone has a definition that their facility uses. I have told him this is one way to show severity of illness for those severe copd patients.
Thanks,
Laura
Thanks,
Laura
Comments
for you. As a FYI, the Pulmonologist at my facility reviewed this as
part of its development.
Hope it helps.
Robert
Robert S. Hodges, BSN, MSN, RN, CCDS
Clinical Documentation Improvement Specialist
Aleda E. Lutz VAMC
Mail Code 136
1500 Weiss Street
Saginaw MI 48602
P: 989-497-2500 x13101
F: 989-321-4912
E: Robert.Hodges2@va.gov
"We are dealing with Veterans, not procedures; With their problems, not
ours." --General Omar Bradley
WOW! I find this very interesting. Our facility uses a program for CDS/CDI through a Consultant Group called Claro/CDR2.
Two weeks ago when they visited and evaluated our program for the first 6 month time period since the inception of our contact with them. One of the query examples they gave us dealt with "Respiratory Failure". On THEIR example, one of the indicators for "resp failure" was that-INTUBATION WAS NOT REQUIRED. On your query, it specifically states "vent support required". I would be interested to know if anyone else has issues with this?
Claro being our Consultant, and being updated constantly in regards to AHIMA practices and Standards, as well as update MEDICARE standards of practice and expectations-makes me wonder which is correct?
Anyone else have any comments?
Juli Bovard RN
Clinical Documentation Specialist
Clinical Effectiveness/Clinical Quality
Rapid City Regional Hospital
719-4390 (work)
786-2677 (cell)
"No Limit to Better......"
Renee
Linda Renee Brown, RN, CCRN, CCDS
Certified Clinical Documentation Specialist
Banner Good Samaritan Medical Center
The query form just provides examples where it may be appropriate to make the determination. A major feature of the query forms we use is for provider and coder education. The form was developed in an effort to not be leading in nature. That is why it has definitions for acute and chronic failure and includes references.
But in any event, the final diagnosis is still up to the physician.
Robert
Robert S. Hodges, BSN, MSN, RN, CCDS
Clinical Documentation Improvement Specialist
Aleda E. Lutz VAMC
Mail Code 136
1500 Weiss Street
Saginaw MI 48602
P: 989-497-2500 x13101
F: 989-321-4912
E: Robert.Hodges2@va.gov
"We are dealing with Veterans, not procedures; With their problems, not ours." --General Omar Bradley
Comments?
Opinions?
Carla D. Fowler, RN MBA
Director Case Management/CDI
Colquitt Regional Medical Center
3131 South Main Street
Moultrie, GA 31788
V 229-891-9363
cfowler2@colquittregional.com
respiratory failure'.
Respiratory failure is a life-threatening disorder that requires close
patient monitoring and evaluation, with aggressive management usually
requiring placement of the patient in a monitored bed, aggressive
respiratory therapy, and/or mechanical ventilation. However, the absence
of mechanical ventilation does not preclude the diagnosis of respiratory
failure
Reference:
AHA Coding Clinic* for ICD-9-CM, 2Q 1990, Volume 7, Number 2, Pages
20-21
Diagnosis of Respiratory Failure Based On Measurements Of Blood Gases
Question:
The guidelines published in Coding Clinic, Third Quarter 1988, page 7,
state that the firm diagnosis of respiratory failure is based on
measurement of blood gases. "The diagnosis is generally used when the
arterial PaO2 falls below 60 mm Hg and/or the arterial PaCO2 rises above
50 mm Hg."
If a patient with an acute exacerbation of COPD is admitted with an
arterial PaO2 of 52 mm Hg and improves to a PaO2 of 74 during the
hospitalization should the diagnosis of respiratory failure be coded
based on the published criteria?
Answer:
No, arterial blood gas determinations are only one of the supportive
clinical findings. Other determinations must be taken into consideration
before the diagnosis of respiratory failure is determined. The article
previously published in Coding Clinic discusses in detail the importance
of interpreting blood gas determinations in light of the patient's usual
status (such as with COPD) before a diagnosis of respiratory failure can
be made.
A patient with acute respiratory failure usually presents with increased
work of breathing as typified by rapid respiratory rate, use of
accessory muscles of respiration (such as intercostal muscle
retraction), and possibly paradoxical breathing and/or cyanosis.
Respiratory failure is a life-threatening disorder that requires close
patient monitoring and evaluation, with aggressive management usually
requiring placement of the patient in a monitored bed, aggressive
respiratory therapy, and/or mechanical ventilation. However, the absence
of mechanical ventilation does not preclude the diagnosis of respiratory
failure.
In addition to the guidelines in Coding Clinic, Third Quarter 1988, page
7, the arterial blood gas pH is also helpful in determining respiratory
failure in a patient with known chronic lung disease. When arterial
blood gas pH is less than 7.35, this is often associated with
respiratory failure in such patients
Paul Evans, RHIA, CCS, CCS-P
Supervisor, Clinical Documentation Integrity, Quality Department
California Pacific Medical Center
2351 Clay #243
San Francisco, CA 94115
Cell: 415.637.9002
Fax: 415.600.1325
Ofc: 415.600.3739
Amy
http://www.acphospitalist.org/archives/2011/03/coding.htm
Renee
Linda Renee Brown, RN, CCRN, CCDS
Certified Clinical Documentation Specialist
Banner Good Samaritan Medical Center
I feel like Claro/CDR 2 really helped us put our program to the forefront for improvement and physician compliance. I was so impressed with the representatives that came to our evaluation from Claro. They were medically knowledgeable, and still, even after they have gone are approachable and I use them as a resource. A benefit is, that your institution can really design/amend the program to your needs!
The one downfall is, there have been little "glitches" for us and the support team is not always too quick to respond to e-mails, so I just started "calling" him to expedite the issue!
Good luck I would suggest using Claro.
Juli