Health Information Management

Q&A: Educating physicians on need to document chronic respiratory failure

CDI Strategies, April 1, 2009

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Q: I’ve heard that when a patient is on home oxygen we should query the physician for chronic respiratory failure. Often in these cases the physician will document a diagnosis of chronic obstructive pulmonary disease (COPD) and does not want to document chronic respiratory failure because he or she thinks the COPD diagnosis is enough, and that it is redundant to write anything else. Other than explaining to the physician that we code chronic respiratory failure separately from the COPD, what else can we do to help them understand the difference between these two diagnoses?

 

A: As not all patients with COPD require chronic oxygen therapy, it is important to document chronic respiratory failure to denote the level of severity in a patient with COPD. There is no other way of distinguishing patients with severe COPD from other degrees of COPD, other than by documenting associated co-morbid illnesses such as chronic respiratory failure. 

 
Explain to your physician there are no ICD-9-CM codes to report the levels of FEV1 (forced expiratory volume in one second is the volume exhaled during the first second of a forced expiratory maneuver started from the level of total lung capacity) or stages of COPD.
 
Those who pay for and profile healthcare outcomes won’t fully understand the need for the increased healthcare resources and poor outcomes of patients with severe COPD (such as the example described above) unless you report associated co-morbid illnesses.
 
Editor’s Note: William E. Haik, MD, director of DRG Review, Inc., in Fort Walton Beach, FL, answered this question. Contact him at Drgreview@aol.com.



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