Health Information Management

Tip: Examine emergency documentation to ensure compliant coding for ARF

CDI Strategies, September 17, 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 (refer to 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 acute respiratory failure depends on several factors, says Robert S. Gold, MD, CEO of DCBA, Inc., in Atlanta, GA.. When acute respiratory failure from an underlying condition causes the inpatient admission, the circumstances of the admission determines if the code for the respiratory failure is sequenced first.  Certain exceptions exist—if the patient is septic and has acute respiratory failure, then the sepsis codes precede the 518.xx codes.  If the acute respiratory failure is due to an infectious process in an AIDS patient, code 042 must be sequenced first. “Both clinical circumstances and coding regulations lead to determination of the position of the acute respiratory failure code,” Gold says. “The major issue is the determination that it was present on admission regardless of the circumstances.”

Remember to refer to emergency room 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 emergency room, 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.

As a best practice, CDI professionals should review each chart in its entirety, DeVault says. This simple shift in focus, she adds, shines the spotlight on strong documentation and accurate reimbursement, rather than increased reimbursement.

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