Any Pediatric Coders/CDI want to help me with this one. It is RSV Bronchiolitis season at our hospital and we have a question about the kids who come in with respiratory distress after study they are diagnosed with rsv bronchiolitis. A. Do we query for acute respiratory distress? Or do we consider the respiratory distress an integral part of the rsv bronchiolits and not even code it. (CC 91 2 Q uses copd as an example that acute respiratory distress is integral to copd) or B. Do we query every time pt comes in with respiratory distress for the acuity? C. If we get acute respiratory distress (518.82) which is not a "symptom" code and plain respiratory distress (786.09) is a symptom code... do we assume we can pick either as the pdx (rsv bronch or acute respiratory distress) depending on resources used (However, I think they would probably use the same resources to treat both.)?

We are using the APR-DRG for most of these kids and the acute respiratory distress moves the soi up and I am struggling a bit with this because I think the respiratory distress is part of the bronchiolitis. Any thoughts would be greatly appreciated. Thank you!