coding acute resp distress in pediatrics

joyce_williams_30088joyce_williams_30088
in Pediatrics
For those hospitals who have pediatrics, are you capturing and coding acute respiratory distress for pts with a pdx of Bronchiolitis?

Symptoms/treatments may include:
· Increased work of breathing, increased respiratory rates
· Head-bobbing
· Grunting
· Nasal flaring
· Retractions
· Oxygen requirement
· Other respiratory treatments such as continuous nebulizers, high-flow nasal canula, BIPAP, deep NP suctioning

Comments

  • cmclose@saintfrancis.comcmclose@saintfrancis.com
    edited May 2016
    Acute resp distress is considered integral to bronchiolitis so it should not be captured is what I was instructed by coding. Anyone else heard differently?

    Claudine Hutchinson RN
    Clinical Documentation Improvement Specialist
    Children's Hospital at Saint Francis

  • ssalinasssalinas
    edited May 2016
    I don't believe there are any rules or exclusions that would preclude coding both bronchiolitis and acute respiratory distress from a coding standpoint. Acute respiratory distress is included in COPD and other chronic respiratory diseases (emphysema, chronic obstructive asthma etc) and therefore it should not be coded separately(see CC below). However there is no such reference for bronchiolitis or other acute conditions that I am aware of.

    Acute respiratory insufficiency w/COPD
    Coding Clinic, Second Quarter 1991 Page: 21 Effective with discharges: April 1, 1991
    Respiratory insufficiency is an integral part of COPD and is included in any COPD code; including specific types such as chronic obstructive bronchitis (491.2), emphysema (492.X), and chronic obstructive asthma (493.2X), as well as COPD, not elsewhere classified (496). Do not assign 518.82 as an additional code.

    Other opinions?

    Sharon

  • Linda_RhodesLinda_Rhodes
    edited May 2016


    We review peds charts and capture acute respiratory distress (518.82)
    with both of the acute bronchiolitis as pdx (466.1 and 466.19).
    I verified this with our coding dept.
    Hope this helps!
    Thanks,
    Linda


    Linda Rhodes RN, BSN, CCDS
    Manager Clinical Documentation Improvement
    New Hanover Regional Medical Center
    Wilmington, North Carolina
    Office # 910-815-5544
    Cell " 910-777-8344
    e-mail : linda.rhodes@nhrmc.org
  • joyce_williams_30088joyce_williams_30088
    edited May 2016
    thank you for all of your replies...

  • Linda_RhodesLinda_Rhodes
    edited May 2016
    Hi Jeff,
    Both scenarios. Initially they would document respiratory distress and we would query for the acuity, but they have improved and now document without querying so much.
    We did a lot of research with coding before we queried. There are some exclusions with the respiratory diagnoses and the encoder will give you an edit. 518.82 is excluded with 491.2,492,493.2 and 496. However no exclusion for 466.1 (acute bronchiolitis).

    Thanks,
    Linda


    Linda Rhodes RN, BSN, CCDS
    Manager Clinical Documentation Improvement
    New Hanover Regional Medical Center
    Wilmington, North Carolina
    Office # 910-815-5544
    Cell " 910-777-8344
    e-mail : linda.rhodes@nhrmc.org
  • ssalinasssalinas
    edited May 2016
    I checked with 3M and this is their response:



    In my opinion it is appropriate to report both acute respiratory insufficiency with bronchiolitis.

    The ICD-9-CM Tabular List does not include any coding instructions restricting the assignment of diagnosis code 518.82 (other pulmonary insufficiency) with code 466.19 (acute bronchiolitis due to other infectious organisms). I was not able to find any references that stated that acute respiratory distress was inherent to bronchiolitis, though bronchiolitis includes "labored breathing".

    Thank you!
    Leslie Hudson, MPH, RHIA, CCS | Nosology Coding Support
    3M Health Information Systems
    575 West Murray Blvd, Murray | UT 84123
    Office: 801 265 4316
    support.3mhis.com





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