Coding and Sequencing Guidelines for Respiratory Failure
Whether it’s ICD-9-CM or ICD-10-CM, the coding guidelines are actually the same for Respiratory Failure. The only difference is the code itself. It’s not only important for a coder to be familiar with these guidelines but also some of the basic clinical indicators as well.
- Life-threatening condition that may be caused by a respiratory condition as well as a non-respiratory condition.
- Look for documented signs / symptoms of:
- SOB (shortness of breath)
- Delirium and/or anxiety
- Use of accessory muscles
- Depressed consciousness
- Cyanosis (bluish color to skin, lip and/or fingernails)
- Acute Respiratory Failure is supported as principal diagnosis when at least 2 of the following critical values (ABG’s) are met.
- pH < 7.35
- PO2 < 55
- PCO2 > 50
Keep in mind, this is a guideline and not solely to be the determining factor for diagnosing Acute Respiratory Failure. A patient with a chronic lung disease such as COPD may have an abnormal ABG level that could actually be considered that particular patient’s baseline. What is normal for one patient could be abnormal for another. In a patient with a chronic lung condition, the physician would consider the degree of change from a patient’s baseline before diagnosing Acute Respiratory Failure.
- Acute Respiratory Failure
- Develops quickly
- Usually admitted to ICU
- Requires aggressive and/or emergency treatment via oxygen through nasal cannula, face mask, ventilation and/or tracheostomy
- Absence of vent does not preclude diagnosis
- Requires close monitoring and evaluation
- Chronic Respiratory Failure
- Develops slowly
- Last longer
- Home O2 is one indication of CRF
Four classifications types for ARF
- Hypoxic – most common
- Hypercapnia – often accompanied by hypoxemia
- Shock – Septic, Cardiogenic or Hypovolemic
Acute Respiratory Failure as Principal Diagnosis
When coding Respiratory Failure (or any condition) and trying to determine whether it should be assigned as principal diagnosis or not, look for:
- All signs and symptoms at the time of admission
- Clinical indicators
- Supporting physician documentation
- Treatment plans
With any record, keep in mind that because a condition may be present on admission does not necessarily mean if qualifies for principal diagnosis. You have to ask yourself these questions:
- After study, is this the condition that was chiefly responsible for admission?
- How aggressive was the work-up and treatment?
- Is there another condition that equally meets the criteria for principal diagnosis?
- Are there any chapter specific guidelines to consider?
- Could this condition have been treated as an outpatient?
I wish I could say that assigning the appropriate principal diagnosis and coding in general was as easy as ABC, but it’s not. Some are a little easier than others but there seems to always be a little gray area to muddle through. Clear and precise documentation goes a long way in helping to determine the principal diagnosis.
As you take on a record to code, forget about the one you just finished. Each record and the circumstances surrounding the admission will be different. Always be aware of the coding guidelines and follow through the steps listed above. You’ll find that assigning the principal diagnosis will be a little easier.
Article by Marsha Manning
This material was compiled to share information. MMP, Inc. is not offering legal advice. Every reasonable effort has been taken to ensure the information is accurate and useful