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

Comments

  • edited May 2016
    Attached is my respiratory failure query form that contains a definition
    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



  • Robert
    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......"



  • Robert may have a different explanation, but I read his query form to mean that ventilatory support is one of the possible criteria the physician can use to determine acute respiratory failure. That is, IF ventilatory support is required, just as IF their PO2 is below 60, or IF the patient cannot speak in full sentences, each one is a criterion that supports the diagnosis. Not that the patient has to meet all the criteria.

    Renee


    Linda Renee Brown, RN, CCRN, CCDS
    Certified Clinical Documentation Specialist
    Banner Good Samaritan Medical Center
  • edited May 2016
    Exactly Renee.

    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

  • edited May 2016
    Anyone had contact with ChartWise software for CDI?
    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

  • MV with intubation is not required to support the code for 'acute
    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

  • I have a query I use for this that we created with the help of one of our intensivists. I have attached it for you. Hope it helps.
    Amy

  • edited May 2016
    We have had a CDMP for over 10 years and we have always followed the guideline that ventilator support is NOT required for respiratory failure. Charlene

  • Link to a physician-written short article on chronic resp failure that you might want to share with your recalcitrant doc:

    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
  • We currently use Claro and I will tell you that the CDS's at our institution (there are 3 of us) are all very impressed with the actual program-but mostly, and most recently with the follow up evaluation Claro provided is with at our 6 month anniversary. They showed us areas to improve upon and our strengths. We took the information Claro gave us from MedPar, O/E ratios, as well as individual physician query response to our Medical Staff meeting last night, and it was the MOST receptive any of the physicians have ever been. I really think it was helpful to show we had actual statistics that were from and independent source and not something we were doing in-house.
    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

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