Health Information Management

When acute respiratory failure isn't really acute respiratory failure

HIM-HIPAA Insider, July 27, 2015

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We are familiar with payment structures as they relate to DRGs or MS-DRGs or per-diem rates or medical necessity elements, as well as the fact that payers for healthcare delivery don't like to pay for diseases that a patient doesn't have.

In some circumstances, a particular diagnosis code will be interpreted as a comorbidity or major comorbidity, or a disease that deserves a particular length of stay and associated cost factors. In other circumstances, a code may act as an inhibitor to getting paid, as in the case of hospital-acquired conditions, or as a ding against the good name of the hospital, as with Patient Safety Indicators or potentially preventable conditions.

Respiratory failure, whether acute or chronic and whether following surgery or not, is one diagnosis that is always an easy target for those who abuse the documentation and assignment of ICD codes.

Continue reading “When acute respiratory failure isn’t really acute respiratory failure” by Robert S. Gold, MD, on the HCPro website. Subscribers to Briefings on Coding Compliance Strategies have free access to this article in the July issue.



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