Where would CDI be without respiratory failure???

annnd2009@gmail.comannnd2009@gmail.com
in CDI Talk Archive
Hello,

I was just wondering about querying for Acute Respiratory Failure (hypoxic) in the setting of cardiac arrest? I have seen queries for it a couple times lately. I wondered thoughts... I guess if there is a respiratory situation going on before... but if the pt just has a cardiac arrest... wouldn't it be inherent?

I kind feel some gray fuzzy areas along these lines with expired cases... acute respiratory failure, encephalopathy... are they not somewhat inherent?

I appreciate others thoughts on how they approach these.

thank you,
Ann

Comments

  • charlenet@chaduath.comcharlenet@chaduath.com
    edited March 2016
    Respiratory Failure in the 2016 CDI Pocket Guide states as follows:

    Definition
    Acute respiratory failure is defined as abnormal arterial oxygenation and/or carbon dioxide accumulation. Common causes include pneumonia, asthma, exacerbation, heart failure, pulmonary embolism, COPD exacerbation and cardiac arrest.


    I would make sure there are clinical indicators to support a query.


    Charlene Thiry, RN, BSN, CPC, CCDS
    Clinical Documentation Specialist
    Phone: 913-796-5944
    charlene.thiry@TrustHCS.com
    www.TrustHCS.com

    Read our blog: http://www.trusthcs.com/blog/



  • annnd2009@gmail.comannnd2009@gmail.com
    edited March 2016
    I guess I have a bit of clinical unease in that how do you NOT have respiratory failure if the heart stops? Doing CPR-cardiopulmonary resuscitation.... Seems to imply both. ??

  • annnd2009@gmail.comannnd2009@gmail.com
    edited March 2016
    I wanted to add the query was written acute hypotenuse respiratory failure in the setting of cardiac arrest.




    >
  • Unknown
    edited March 2016
    Guys - too much overthinking. Cardiac arrest leads to stoppage of function of all organs eventually. If the cardiac arrest occurred in the process of dying of something else, like end stage lung cancer, the heart stoppage is part of dying and isn't coded at all. Cardiac arrest due to total blockage or transmission of impulses as in total heart block is I46.2. Cardiac arrest due to acute MI is I46.2. Cardiac arrest due to ventricular fibrillation is I46.2. All other cardiac causes are I46.2. Sudden cardiac arrest with no apparent cause identified at all or guessed at is I46.9. If it is due to electrolyte issues such as potassium or calcium, then there might be I46.8. Hemorrhagic shock can lead to demand arrest - I46.8. In all of these cases, breathing stops. CPR is performed for cardiorespiratory arrest - which is I46.x. There has to be a primary lung disease that will permit additional coding of acute hypoxemic respiratory failure. Now, if acute hypoxemic respiratory failure due to a disease, drowning or trauma or smoke inhalation or even due to acute pulmonary edema, leads to cardiac arrest through demand ischemia or true STEMI, then you have both codable. Otherwise, it's playing with codes for dollars and is wrong.



    Robert S. Gold, MD
    CEO, DCBA, Inc
    4611 Brierwood Place
    Atlanta, GA 30360
    (770) 216-9691 (Office)
    (404) 580-0204 (Cell)

  • annnd2009@gmail.comannnd2009@gmail.com
    edited March 2016
    Hi

    You always give so much great info but want to make sure I understand.

    I am not trying to query for this I have just taken over a case where this has been asked and it didn't seem to make sense that cardiac arrest COULD NOT. Have respiratory failure. I was just trying to make sure I was thinking clearly.

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