coding clinic for respiratory failure and pneumonia

Comments

• ssalinas

  February 2013 edited May 2016

  The CCs below superceded the 2003 Q2 advice. There are numerous other citations but these two kind of say it all.
  Aspiration pneumonia and acute respiratory failure - clarification
  Coding Clinic, First Quarter 2008 Page: 18 to 19 Effective with discharges: March 21, 2008
  Related Information
  
  
  Acute Respiratory Failure and Aspiration Pneumonia
  
  Question:
  
  When acute respiratory failure is present on admission along with aspiration or bacterial pneumonia and both conditions are equally treated can either condition be sequenced as the principal diagnosis? Updated coding guidelines for acute respiratory failure were published in Coding Clinic First Quarter 2005, pages 3-8, which superseded previously published advice. However, information published in Coding Clinic Second Quarter 2003, pages 21-22, stating respiratory failure and pneumonia are not co-equal was not rescinded. Since this has caused a great deal of confusion in the field please clarify.
  
  For example, a 90-year-old nursing home resident was admitted to the hospital with shortness of breath, elevated white blood cell count, and bibasilar infiltrates. The provider diagnosed aspiration pneumonia and acute respiratory failure and both conditions were present on admission. Intravenous antibiotics were administered, oxygen therapy was provided and her clinical condition improved. Due to the possibility of chronic obstructive pulmonary disease (COPD), she was started on Advair. After the patient experienced a few runs of paroxysmal supraventricular tachycardia, Metoprolol therapy was initiated. The patient was transferred to the SNF in stable condition following an uneventful hospital course. Which diagnosis should be sequenced as the principal diagnosis, aspiration pneumonia or acute respiratory failure?
  
  Answer:
  
  In this case, sequence either code 507.0, Pneumonitis due to inhalation of food or vomitus, or code 518.81, Acute respiratory failure, as the principal diagnosis. The Official Guidelines for Coding and Reporting regarding two or more diagnoses that equally meet the definition for principal diagnosis state, "In the unusual instance when two or more diagnoses equally meet the criteria for principal diagnosis as determined by the circumstances of admission, diagnostic workup and/or therapy provided, and the Alphabetic Index, Tabular List, or another coding guidelines does not provide sequencing direction, any one of the diagnoses may be sequenced first."
  
  Please note that the information published in Coding Clinic First Quarter 2005, pages 3-8, superceded all other previous issues dealing with respiratory failure. Whenever new advice is published it always supercedes earlier advice.
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  Respiratory failure
  Coding Clinic, First Quarter 2005 Page: 3 to 4 Effective with discharges: April 20, 2005
  Related Information
  
  
  Respiratory Failure
  
  Note from 3M:
  As of October 1, 2011, codes have been created to distinguish postoperative acute respiratory failure from less severe respiratory conditions. See Coding Clinic, Fourth Quarter 2011, pages 123-125 for more information.
  
  The Central Office has continued to receive numerous requests regarding the sequencing of respiratory failure. The following instruction has been developed by the Cooperating Parties to provide clarification. Some of the principles outlined below are consistent with previously published advice, and some contain revised information. Please review carefully these principles along with the accompanying examples.
  
  Code 518.81, Acute respiratory failure, may be assigned as a principal diagnosis when it is the condition established after study to be chiefly responsible for occasioning the admission to the hospital, and the selection is supported by the Alphabetic Index and Tabular List. However, chapter-specific coding guidelines (obstetrics, poisoning, HIV, newborn) that provide sequencing direction take precedence. Respiratory failure may be listed as a secondary diagnosis if it occurs after admission.
  
  When a patient is admitted with respiratory failure and another acute condition, (e.g., myocardial infarction, cerebrovascular accident), the principal diagnosis will not be the same in every situation. Selection of the principal diagnosis will be dependent on the circumstances of admission. If both the respiratory failure and the other acute condition are responsible for occasioning the admission to the hospital, the guideline regarding two or more diagnoses that equally meet the definition for principal diagnosis (Section II, C,) may be applied in these situations.
  
  The advice above supercedes guideline #1 and guideline #2, previously published in Coding Clinic, Second Quarter 1991, page 3. This information is consistent with advice previously published in Coding Clinic, November-December 1987; Second Quarter 1990, page 11-12; Third Quarter 1991, page 14; First Quarter 1993, page 25;Second Quarter 2000, page 21; and First Quarter 2003, page 15.
  
  Respiratory failure is a life-threatening condition that is always due to an underlying condition. It is usually the final pathway of a disease process, or a combination of different processes. It can arise from an abnormality in any of the components of the respiratory system, central nervous system, peripheral nervous system, respiratory muscles and chest wall muscles. Patients with acute respiratory failure require repeated assessments and close observation. The primary thrust of treatment is usually towards correction of the hypoxemia and stabilization of the ventilatory and hemodynamic status.
  
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  Respiratory failure and congestive heart failure
  Respiratory failure due to status asthmaticus
  Respiratory failure due to postpartum pulmonary embolism
  Respiratory failure due to crack overdose
  Respiratory failure due to AIDS related Pneumocystis carinii
  Respiratory failure and sepsis
  
  
  
  
  © Copyright 1984-2012, American Hospital Association ("AHA"), Chicago, Illinois. Reproduced with permission. No portion of this publication may be copied without the express, written consent of AHA.
  
  
  © Copyright 1984-2012, American Hospital Association ("AHA"), Chicago, Illinois. Reproduced with permission. No portion of this publication may be copied without the express, written consent of AHA.