Duration Of Mechanical Vent for ICD10-PCS

valwy

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If a patient is intubated in the field and comes to the ED, placed on the ventilator in ED and later admitted, when do you count the start of the ventilator time?

Coding clinic states that if the patient is intubated PTA, the start time for counting duration is the time of admission. Is that the time the vent is started in the ED or is it the official time of admission to inpatient status per physician order?

Thanks for input.
 

cmontyrn

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Counting duration of mechanical ventilation ICD-10-PCS

What counts when calculating ventilator hours:
The number of hours the patient spends on a mechanical ventilator while he or she is in observation or in the ER prior to admission. See Coding Clinic, Second Quarter 1992, pp. 13–14.

Coding Clinic has yet to provide guidance regarding what to do in scenarios where a patient doesn't receive a full hour of ventilator support.

Coders should always refer to the respiratory flow sheet before coding any services related to ventilator support. This flow sheet includes the intubation time, periodic dating and timing of ventilator management services, and the extubation time. Coders shouldn't rely entirely on physician orders of intubation and extubation times. Coders need to go by the actual documentation. They need to have solid documentation of the times.


See link to News: RACs target ventilator support
http://www.hcpro.com/HIM-268822-5707/News-RACs-target-ventilator-support.html
CDI Strategies, July 21, 2011

RACs can easily data-mine for noncompliance related to coding for ventilator support, says Glenn Krauss, BBA, RHIA, CCS, CCS-P, CPUR, C-CDI, CCDS,independent revenue cycle consultant in Madison, WI. For example, patients whose length of stay is fewer than two days can’t possibly be on a ventilator for 96 hours. "Simple math tells you this can't be correct," Krauss says. "Technically speaking, they almost don't even need to look at the record; they can tell by an automated review."

Coders should always refer to the respiratory flow sheet before coding any services related to ventilator support, he says. This flow sheet includes the intubation time, periodic dating and timing of ventilator management services, and the extubation time.

"If coders don't have the flow sheet, they absolutely need to track it down," Krauss emphasizes, adding that a hospital's coding compliance policy should explicitly mandate this.

Coders shouldn't rely entirely on physician orders of intubation and extubation times, agrees Alice Zentner, RHIA, director of auditing and education at TrustHCS in Springfield, MO. "Coders need to go by the actual documentation. They need to have solid documentation of the times," she says.

However, even when documentation exists, counting the number of ventilator hours can sometimes be confusing. Coding Clinic has yet to provide guidance regarding what to do in scenarios where a patient doesn't receive a full hour of ventilator support, says Zentner. For example, should coders report an additional hour of ventilation when the patient receives only 25 minutes? Without definitive guidance, Zentner cautions against it.

Here are a few pointers on what can count when calculating ventilator hours:
The number of hours the patient spends on a mechanical ventilator while he or she is in observation or in the ER prior to admission. See Coding Clinic, Second Quarter 1992, pp. 13–14.
The number of hours the patient receives continuous invasive mechanical ventilation, such as continuous positive airway pressure (CPAP) and bi-level positive airway pressure (BiPAP), when delivered through an endotracheal tube or tracheostomy. See Coding Clinic, Fourth Quarter 2008, p. 187.

Here's what coders can't include when counting ventilator hours and what RACs may look for when trying to identify overpayments:
The number of hours the patient spends on the mechanical ventilator before he or she arrives at the hospital. See Coding Clinic, Third Quarter 2010, p. 3.
The number of hours the patient receives noninvasive mechanical ventilation (e.g., CPAP and BiPAP) not delivered via an endotracheal tube or tracheostomy. See Coding Clinic, Fourth Quarter 2008, p. 187.
The number of hours the patient receives manual ventilation, such as when an emergency medical technician performs manual bagging while the patient is in the ER. Ventilation time starts when the patient is placed on a mechanical ventilator. See Coding Clinic, Second Quarter 2003, p. 17.
The number of hours spent weaning the patient off the mechanical ventilator. See Coding Clinic, 4th Quarter 2014. After the mechanical ventilator is turned off, it is inappropriate to continue to count ventilation hours, even though the patient is continually being evaluated.
CDI specialists need to be aware of the expectations and limitations of what coders can and cannot use and help to obtain clarity for such situations when warranted.



See also video ICD-10 Coding Clinic Update: Complex Issues with Multiple Examples
https://www.libmaneducation.com/icd-10-coding-clinic-update-complex-issues-multiple-examples/

Mechanical Ventilation Coding Clinic Q4 2014
The ICD-10-PCS provides three codes to describe the duration patients are on mechanical (respiratory) ventilation as follows:

5A1935Z Respiratory Ventilation, Less than 24 Consecutive Hours
5A1945Z Respiratory Ventilation, 24-96 Consecutive Hours
5A1955Z Respiratory Ventilation, Greater than 96 Consecutive Hours

Question: A patient, who has suffered acute respiratory failure (ARF), is admitted to long term care hospital (LTCH) for ventilator weaning. One day one ... One day five, the ventilator was turned off and the patient was extubated.
According to clinical protocol at our facility, a patient is not "officially" weaned until he has been totally off of the ventilator for 72 hours. Until the patient successfully completes the weaning trial period, he is continually evaluated.
Can we count the additional 72 hours as vent time, since evaluation and monitoring is part of the weaning process?

Answer:
Assign ICD-10-PCS code 5A1955Z (Respiratory Ventilation, Greater than 96 Consecutive Hours), since the ventilator was turned off on day five.

After the mechanical ventilator is turned off, it is inappropriate to continue to count ventilation hours, even though the patient is continually being evaluated.

The additional 72 hours that the patient is evaluated is not included in the ventilation time.
 

rbandaru

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As per guideline coder need to consider the ventilation time from the ventilator started in ED.
5A1935Z Respiratory Ventilation, Less than 24 Consecutive Hours
5A1945Z Respiratory Ventilation, 24-96 Consecutive Hours
5A1955Z Respiratory Ventilation, Greater than 96 Consecutive Hour

Regards
Dr.Ramnath Bandaru, CCS, CPC
American Medical Services LLC
http://amshealth.com/
Twitter: @HospitalCoders
 
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cmontyrn

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In answer to your question " how often can we report code 5A1955Z during hospital stay?"

I found relevant information in the 2016 ICD-10-CM and PCS Coding Handbook by Nelly Leon-Chisen :
from this source it states that if it is greater than 96 hours and removed without reinsertion, you code it once without consideration of time over 96 hour mark.*

If more than one incident of mechanical ventilation, you code each one for the representative length of time. The subsequent one(s) would have to be after periods of time when provider saw improvement enough to feel patient would be stable without it, but then deteriorated after being extubated for an extended period of time.*

As per guideline coder need to consider the*ventilation*time from the ventilator started in ED.
5A1935Z Respiratory*Ventilation, Less than 24 Consecutive Hours
5A1945Z Respiratory*Ventilation, 24-96 Consecutive Hours
5A1955Z Respiratory*Ventilation, Greater than 96 Consecutive Hour.
 
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