ED Coding and Reimbursement Alert

Question: We saw a patient who presented for a COPD exacerbation and he went into acute respiratory failure. We reported the ARF code but our administrator says that’s not appropriate. Is that not meant to be a primary diagnosis?

Codify Subscriber

Answer: According to ICD-10 guidelines, if acute respiratory failure (ARF) is the primary reason for the patient’s visit, then you may choose an appropriate code from subcategory J96.0- (Acute respiratory failure…), or subcategory J96.2-, (Acute and chronic respiratory failure…) as the primary diagnosis.

But if the ARF occurs later, the rules change. “Respiratory failure may be listed as a secondary diagnosis if it occurs after admission, or if it is present on admission, but does not meet the definition of principal diagnosis for hospital reporting guidelines,” the 2018 ICD-10-CM Official Guidelines for Coding And Reporting say.

When ARF is coexistent with another acute condition, (such as myocardial infarction [I21.-, I22.-], cerebrovascular accident [I63.-], aspiration pneumonia J69.- [Pneumonitis due to solids and liquids…]), the selection of principal diagnosis will be different according to the situation.

In this situation, selecting the correct code can be a little tricky, depending on whether the other existing pathology is respiratory or non-respiratory in nature, and also on the circumstances of admission. Here’s how to make your decision:

• If both ARF and the other acute condition are equally responsible for patient’s admission, check for any chapter specific sequencing rules or any chapter specific guidelines that lead you to zero in on the primary diagnosis.
• If the documentation does not make it clear whether ARF and the other condition were equally instrumental in effecting the patient’s admission, you may have to ask the provider for further clarification.