Ambulance coding for patient on ventilator

moodyk13

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Flowery Branch, GA
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I am hoping there are some ambulance coder experts in here even though there isn't a separate forum for one. We are presented with a patient, who during surgery for toe amputation went into cardiac arrest. He is now on a ventilator and being transported to a long term acute care hospital. The following info is what the crew documented:

CREW FOUND PATIENT SEDATED AND ON A VENTILATOR UPON OUR ARRIVAL, PATIENT'S WIFE WAS IN THE ROOM WITH HIM., PATIENT SKIN TEMP WAS WARM AND DRY. CRT < 2 SECONDS, PATIENTS LUNGS ARE CLEAR, EQUAL BILATERAL, PATIENT LOOKS TO BE A LITTLE SWOLLEN. PATIENT HAS NOT BEEN ABLE TO HAVE DIALYSIS. PATIENT HAS A FALSE LEFT EYE, RIGHT LEG AMPUTEE BELOW THE KNEE AND HE JUST HAD THREE TOES REMOVED OFF HIS LEFT FOOT WHEN HE WENT INTO CARDIAC ARREST IN THE OR. PATIENT NON RESPONSIVE DUE TO MEDICATION. RESPITORY IS IN THE ROOM WITH EMS ALONG WITH RN. EMS IS GIVEN THE SETTING FOR THE VENTILATOR. PATIENT IS PUT ON OUR VENTILATOR AND ALL IS WORKING WELL, PATIENT IS SATTING AT 100%, PATIENT IS MOVED TO OUR STRETCHER BY SIX PEOPLE AS A UNIT. PATIENT IS PLACED ON CARDIAC MONITOR SHOWING NORMAL SINUS RHYTHM. THE IV PUMP WITH DIPRIVAN GOING IS PLACED ON IV POLE ON STRETCHER @ 10 MCG/KG/MIN . PATIENT IS SECURED TO THE STRETCHER USING ALL AVALIABLE STRAPS. EMS CHECKS PATIENTS LUNG SOUNDS TO MAKE SURE TUBE PLACEMENT IS GOOD,,LUNG SOUNDS IN BOTH SIDES. EMS GETS PAPERWORK AND MOVES PATIENT TO AMBULANCE VIA STRETCHER AND LOADED CAREFULLY. EMS CHECKS LUNG SOUNDS AGAIN TO MAKE SURE TUBE HAS NOT BEEN MOVED,,LUNG SOUNDS GOOD PATIENT STILL SATTING AT 100%. PATIENT HAS A CENTRAL LINE IN HIS RIGHT UPPER THORACIC AREA. THAT SITE LOOKS GOOG. PATIENT HAS A SHUNT IN HIS LEFT THORACIC AREA, ALL LOOKS WELL. PATIENT IS MONITORED CLOSELY ENROUTE. EMS DEEP SUCTION PATIENT ENROUTE TO KEEP AIR WAY CLEAR SINCE THIS IS A NEW TRACH. PATIENT VITAL SIGNS AND O2 SAT IS MONITORED CLOSELY. PATIENT HAD NO PERSONAL BELONGINGS. PATIENT MAINTAINED ENROUTE, PATIENT IS TAKEN OUT OF AMBULANCE CAREFULLY ON STRETCHER AND TAKEN TO THE THIRD FLOOR WHERE REPORT AND PAPER WORK WAS GIVEN TO RN. PATIENT IS MOVED FROM STRETCHER TO BED BY SIX PEOPLE AS A UNIT. ALL EQUIPMENT IS SWAPPED OVER. SEE BELOW FOR PAST MEDICAL HISTORY, MEDICATION ,ALLERGIES AND VITAL SIGNS.

So in the ambulance industry, depending on the situation we typically code a condition followed by the reason for an ambulance (ex: primary: R79.89 Other specified abnormal findings of blood chemistry; secondary: R41.82 Altered mental status, unspecified) other times we will have a diagnosis followed by a new condition (ex: F20.0 Paranoid schizophrenia; R45.850 Homicidal ideations)

In this case, I don't know if we should code primary I97.11 NTRAOPERATIVE CARDIAC ARREST DURING OTHER SURGERY secondary Z99.11 DEPENDENCE ON VENTILATOR (which is what I've used currently)
or R40.20 Unspecified coma followed by Z99.11 DEPENDENCE ON VENTILATOR or vice versa z99.11 followed by R40.20

Or even J95.822 Acute and chronic postprocedural respiratory failure followed by Z99.11
or do I use I97.11 with J95.822

Oh my there are some many ones to consider!

Help?
 
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