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Ensure compliant coding for ARF

HIM Connection, September 8, 2009

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The following ICD-9-CM codes denote acute respiratory failure (ARF):

• 518.81, ARF
• 518.82, other pulmonary insufficiency, not elsewhere classified (includes acute respiratory distress, acute respiratory insufficiency, and adult respiratory distress syndrome NEC)
• 518.84, acute and chronic respiratory failure

Check out Coding Clinic, fourth quarter 1998 and first quarter 2005, for more information about when ARF should be the principal diagnosis, as well as documentation requirements.

The sequencing of respiratory failure depends on the reason for admission. When respiratory failure from an underlying condition causes the inpatient admission, the failure becomes the principal diagnosis; when the patient develops respiratory failure after admission, it is the secondary diagnosis and should be coded as such.

Remember to refer to ER notes for much-needed information that may not appear elsewhere in the chart, says Kathy DeVault, RHIA, CCS, manager of professional resources at the American Health Information Management Association in Chicago.

ARF can be resolved fairly quickly in the ER, so it’s possible that the physician will write it once in the chart and it won’t appear again anywhere in the documentation. That doesn’t mean the physician didn’t diagnose or treat it, she notes.

In general, coders need an awareness of each chart in its entirety, DeVault says, adding that this will help them focus on strong documentation and accurate reimbursement, rather than increased reimbursement.

Editor’s note: This tip was adapted from the August issue of Briefings on Coding Compliance Strategies.

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