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 firstname.lastname@example.org.