Wiki Coding Respiratory Insufficiency vs. Failure

Create Wiki
B

bridie25

Networker
Messages
43
Location
Tampa, FL
Best answers
0
I code for a Pulmonologist and he uses Acute Hypoxic Respiratory Insufficiency a lot . I think we should code this as J96.01, my colleague disagrees since it given as insufficiency she thinks we should code R09.02 and R06.89.

Does anyone have some insight on this?
 
Hello,

Respiratory Insufficiency and Respiratory Failure are two different clinical concepts. If insufficiency is documented it should be coded as such.

However, you can always query the physician to make sure he is using terminology in relation to coding concepts. He may be saying acute hypoxic respiratory insufficiency because he feels that is what it is; yet the documented symptoms and vitals qualify the patient for the diagnosis of respiratory failure based on the fact they meet the clinical criteria for that diagnosis. Meaning, a diagnosis code must be supported by the documentation in both terminology and clinical criteria. Therefore, if the physician is still calling it insufficiency, but the it doesn't qualify as such, his documentation needs to be queried for clarity, have an addendum added or he needs to start documenting differently. In the end his professional medical opinion may be that he feels the patient does not qualify for respiratory failure, which in that case , insufficiency should be coded.

These articles help show what qualifies the patient for the diagnosis of respiratory failure. They may be helpful when discussing documentation with the physician. Or you could bring the subject up with your facility CDI professional, if you have one.


Hopefully this helps,
 
You must log in or register to reply here.
Top