Q&A: Sleep Apnea Clarification Opportunities
CDI Strategies, October 23, 2014
Want to receive articles like this one in your inbox? Subscribe to CDI Strategies!
Q: Should I query for chronic respiratory failure if the documentation indicates the patient has sleep apnea and is being treated with continuous positive airway pressure (CPAP) at night?
A: I love where you are going with this question, it demonstrates your critical thinking, one of the most important skills a CDI specialist can have.
First off, let’s think about the definition of respiratory failure and the biological processes which cause it. Respiratory failure can result from an inability to ventilate (take in oxygen, expel carbon dioxide) or an inability for the gas exchange to occur at the cellular level within the lungs.
The Merck Manual describes it as: “A rise in [partial pressure of carbon dioxide] PaCO2 (hypercapnia) that occurs when the respiratory load can no longer be supported by the strength or activity of the system. The most common causes are acute exacerbations of asthma and [Chronic Obstructive Pulmonary Disease] COPD, overdoses of drugs that suppress ventilatory drive, and conditions that cause respiratory muscle weakness (e.g., Guillain-Barré syndrome, myasthenia gravis, botulism)… Treatment varies by condition but often includes mechanical ventilation.”
The Manual goes on to describe that the balance between load resistance to ventilation and neuromuscular competence (the drive to breath and muscle strength) determines the ability to sustain alveolar ventilation. Sleep disordered breathing is listed as a contributing condition that can disrupt this balance.
If you come from case management experience, you might be aware that for a Medicare patient to qualify for CPAP, a sleep study must be performed that demonstrates need based on the number and length of episodes occurring within the study elapsed time.
If the patient is receiving treatment or monitoring within the hospital stay to address the sleep apnea, a query may be warranted. Make sure the hospital is providing CPAP support at night and review the respiratory therapy notes to show consistency within the record before submitting the query.
If your organization does not have agreed upon diagnostic criteria for chronic respiratory failure, work with your CDI team and pulmonologists to define this condition and identify clinical indicators to support the query. Discuss with the pulmonologist how sleep apnea and the use of CPAP supports this diagnosis.
When I was reviewing records I always thought of obesity alveolar hypoventilation syndrome (Pickwickian’s Syndrome) as a possible secondary diagnosis where obstructive sleep apnea was listed as a diagnosis. Check the patient’s BMI and if you have morbid obesity, consider whether that condition led to the obstructive sleep apnea. This also provides a CC.
Smart question and this is often a query opportunity that is overlooked.
Editor’s Note: CDI Boot Camp Instructor Laurie Prescott, RN, MSN, CCDS, CDIP, AHIMA Approved ICD-10-CM/PCS Trainer, answered this question. Contact her at lprescott@hcpro.com. For information regarding CDI Boot Camps offered by HCPro visit www.hcprobootcamps.com/courses/10040/overview.
Want to receive articles like this one in your inbox? Subscribe to CDI Strategies!
Related Products
Most Popular
- Articles
-
- The positive aspect of change
- Practice the six rights of medication administration
- Don’t forget the three checks in medication administration
- Note similarities and differences between HCPCS, CPT® codes
- Differentiate between types of wound debridement
- What to include on the incident report
- OB services: Coding inside and outside of the package
- Complications from immobility by body system
- Know guidelines and subtle differences in code descriptions for laceration repairs
- Q&A: Primary, principal, and secondary diagnoses
- E-mailed
-
- Challenges of antibiotic stewardship in the ICU
- Know the medical gas cylinder storage requirements
- Tip: Coding for inpatient postoperative complications requires explicit documentation
- Capturing start and stop times for infusions
- Bill and charge for supplies correctly to reduce risk and minimize lost revenue
- Get the facts on coding for non-biodegradeable drug delivery implants
- Five keys to creating a CHF disease management program
- Eye flush is included in E/M facility code
- Ensure proper payment from interrupted stays
- Credentialing Resource Center Symposium, March 12-13, in Las Vegas
- Searched
-
- Creating a Successful Modern Telehealth INVALIDem
- sepsis present on admission
- why ambulation is requer for elderly people
- providers
- discharge summary
- Shared governance A practical approach to transfor
- Alzheimers disease and disorder
- Improved communication in facility construction co
- medical executive
- out patient history and physical