Health Information Management

Q&A: Acute respiratory failure diagnosis does not require intubation

CDI Strategies, May 10, 2012

Want to receive articles like this one in your inbox? Subscribe to CDI Strategies!

Q: Our pulmonologists are not comfortable documenting acute respiratory failure unless the patient is on a vent.  Also, they rarely document chronic respiratory failure, even in COPD patients on continuous home oxygen. I’m trying to develop standard query forms for acute and chronic respiratory failure and am running into these obstacles. How do you recommend handling this issue?

A: Consult the AHA’s Coding Clinic for ICD-9-CM, Third Quarter 1988, p. 7, and Second Quarter 1990, pp. 20-21, for references stating that patients in acute respiratory failure do not require intubation. Note also that Murray and Nadel’s Textbook of Respiratory Medicine, fourth edition vol. 2, includes the same arterial blood gas (ABG) criteria for acute respiratory failure and does not require intubation.
I was on the panel of Coding Clinic and worked hard to get that 1988 guidance. This allowed my performance profile to reflect the hospital resources that I had to use in order to prevent intubation in my patients who had COPD and other respiratory illness. Back then the PRO would not allow the reporting of acute respiratory failure unless the patient was intubated, which not only poorly reflected on my profile but represented only the patients with severe acute respiratory failure that did not respond to non-invasive support.
Note that Coding Clinic is not a medical text, but it is an official coding reference and may help with your case.
Editor’s Note: William Haik, MD, FCCP, CDIP, director of DRG Review, Inc., in Fort Walton Beach, FL, and a former member of the ACDIS advisory board, answered this question. Contact him at

Want to receive articles like this one in your inbox? Subscribe to CDI Strategies!

    Briefings on APCs
  • Briefings on APCs

    Worried about the complexities of the new rules under OPPS and APCs? Briefings on APCs helps you understand the new rules...

  • HIM Briefings

    Guiding Health Information Management professionals through the continuously changing field of medical records and toward a...

  • Briefings on Coding Compliance Strategies

    Submitting improper Medicare documentation can lead to denial of fees, payback, fines, and increased diligence from payers...

  • Briefings on HIPAA

    How can you minimize the impact of HIPAA? Subscribe to Briefings on HIPAA, your health information management resource for...

  • APCs Insider

    This HTML-based e-mail newsletter provides weekly tips and advice on the new ambulatory payment classifications regulations...

Most Popular