Lori
Well-known member
Acute respiratory failure comes on suddenly over hours or within a day or two from impaired oxygenation, impaired ventilation, or both. It’s important to review the documentation and check to see if the RR (respiratory rate) is less than 20 or greater than 10, fs there is any wheezing, and/or nasal flaring, accessory muscle use for breathing, etc., as these are signs that can indicate acute respiratory failure is present.
Chronic respiratory failure often develops slowly and is ongoing (months and years) due to the airways that carry air to the lungs are narrowed and damaged. A patient with COPD that has progressed to the end-stage often utilizes portable oxygen daily. The most common cause of COPD is smoking.
Acute and Chronic respiratory failure includes both severities of the failure.
www.starauditing.com
What is ventilator dependence?
Ventilator dependence was defined as the failure to wean the patient from the ventilator while hospitalized in the intensive care unit or respiratory care center, in conjunction with continued use of a ventilator according to hospital discharge status.
Z99.11
Dependence on respirator(ventilator) status
Used to specify conditions or terms like artificial ventilation finding, artificial ventilation finding, dependence on biphasic positive airway pressure ventilation, dependence on biphasic positive airway pressure ventilation, dependence on biphasic positive airway pressure ventilation due to central sleep apnea syndrome, dependence on continuous positive airway pressure ventilation, etc. The code is exempt from the present on admission (POA) reporting for inpatient admissions to general acute care hospitals.
Mechanical Ventilator
According to International Ventilator
Users Network, mechanical ventilation
(i.e., assisted ventilation) is a method to
mechanically assist or replace
spontaneous breathing for people who
cannot breathe on their own.
Mechanical ventilation can be delivered
noninvasively through a face or nasal
mask or invasively with the involvement
of an instrument penetrating through
the mouth (e.g. endotracheal tube) or
the skin (e.g., tracheostomy tube).
Depending on a person’s needs,
mechanical ventilation may be short‐
term or long‐term. Short‐term
mechanical ventilation occurs generally in
a hospital ICU setting for an acute illness
or injury until a person is able to breathe
unassisted. Long‐term mechanical
ventilation may be
of one’s life for those with
neuromuscular, musculoskeletal, and/or
another type of condition or disease that
affects the use of respiratory muscles or
has involvement with the airways.
A ventilator is equipment used to
mechanically assist breathing by
transporting air to the lungs. There are
smaller, portable ventilators for use in
the home setting.
Coding Clinic Advice
Per AHA Coding Clinic 2008, Q1, “BiPAP
involves assisted ventilatory support,
which is designed to augment a patient's
ability to breathe on a spontaneous basis.
The patient is breathing on his own with
BiPAP or CPAP. Although CPAP and BiPAP
are similar, BiPAP provides continuous
positive airway pressure that is higher
when the patient breathes in and lowers
when the patient breathes out. In both
cases the patient is initiating his own
inspirations and exhalations. Both CPAP
and BiPAP are forms of respiratory
the assistance that augments the patient's
breathing. In contrast, mechanical
ventilation pumps air into the lungs even
when there is no attempt by the patient
to breathe independently.”
Coding Reference Status codes Z99.81 (no HCC) for supplemental oxygen are used to report patients on long‐term oxygen therapy, regardless of the duration of use each day.
This status code assignment applies to long‐term oxygen therapy consisting of dependence on ambulatory, continuous, supplemental, and/or nocturnal oxygen therapy. 34 Status code categories Z99.1 (HCC 82) are for use when the patient is dependent on a respirator (ventilator). This code category also includes weaning from a mechanical ventilator and encounters with respiratory (ventilator) dependence during power failure. For weaning from a mechanical ventilator, ICD‐10 coding guidelines state to assign a code from subcategory J96.1 (HCC 84), Chronic respiratory failure, with secondary status code Z99.11 (HCC 82), Dependence on respiratory [ventilator] status. Status codes are for use only when there are no complications or malfunctions of the device.
Ventilator-associated pneumonia (VAP) is a hospital-acquired (nosocomial) condition developing more than 48 hours after the introduction of mechanical ventilation.
Many patients who survive VAP encounter problems while being weaned from the ventilator, thereby developing chronic ventilator dependence.
Ventilator associated Pneumonia
1) Documentation of Ventilator associated Pneumonia
As with all procedural or postprocedural complications, code assignment
is based on the provider’s documentation of the relationship between the
condition and the procedure.
Code J95.851, Ventilator associated pneumonia, should be assigned only
when the provider has documented ventilator associated pneumonia
(VAP). An additional code to identify the organism (e.g., Pseudomonas
aeruginosa, code B96.5) should also be assigned. Do not assign an
additional code from categories J12-J18 to identify the type of
pneumonia.
Code J95.851 should not be assigned for cases where the patient has
pneumonia and is on a mechanical ventilator and the provider has not
specifically stated that the pneumonia is ventilator-associated
pneumonia. If the documentation is unclear as to whether the patient has
a pneumonia that is a complication attributable to the mechanical
ventilator, query the provider.
2) Ventilator-associated Pneumonia Develops after Admission
A patient may be admitted with one type of pneumonia (e.g., code J13,
Pneumonia due to Streptococcus pneumonia) and subsequently develop
VAP. In this instance, the principal diagnosis would be the appropriate
code from categories J12-J18 for the pneumonia diagnosed at the time of
admission. Code J95.851, Ventilator associated pneumonia, would be
assigned as an additional diagnosis when the provider has also
documented the presence of ventilator associated pneumonia.
Chronic respiratory failure often develops slowly and is ongoing (months and years) due to the airways that carry air to the lungs are narrowed and damaged. A patient with COPD that has progressed to the end-stage often utilizes portable oxygen daily. The most common cause of COPD is smoking.
Acute and Chronic respiratory failure includes both severities of the failure.
Respiratory Coding in FY2020 — STAR Medical Auditing Services
Often in emergency and acute care healthcare settings, we find patients with a diagnosis of “Respiratory Failure.” Clinical coding and clinical documentation improvement (CDI) professionals need to have a strong knowledge and understanding of both medical/clinical aspects of diseases as well as the
www.starauditing.com
Ventilator dependence was defined as the failure to wean the patient from the ventilator while hospitalized in the intensive care unit or respiratory care center, in conjunction with continued use of a ventilator according to hospital discharge status.
Z99.11
Dependence on respirator(ventilator) status
Used to specify conditions or terms like artificial ventilation finding, artificial ventilation finding, dependence on biphasic positive airway pressure ventilation, dependence on biphasic positive airway pressure ventilation, dependence on biphasic positive airway pressure ventilation due to central sleep apnea syndrome, dependence on continuous positive airway pressure ventilation, etc. The code is exempt from the present on admission (POA) reporting for inpatient admissions to general acute care hospitals.
Approximate Synonyms
The following clinical terms are approximate synonyms or lay terms that might be used to identify the correct diagnosis code:- Artificial ventilation finding
- Dependence on biphasic positive airway pressure ventilation
- Dependence on biphasic positive airway pressure ventilation due to central sleep apnea syndrome
- Dependence on continuous positive airway pressure ventilation
- Dependence on home ventilator
- Dependence on non-invasive ventilation
- Dependence on respirator
- Dependence on respiratory device
- Dependence on ventilator
- Dysfunctional ventilatory weaning response
- Equipment in use
- Patient ventilated
- Uses home bilevel positive airway pressure ventilation
- Uses home continuous positive airway pressure ventilation supply
- Weaning from mechanically assisted ventilation not achieved
Mechanical Ventilator
According to International Ventilator
Users Network, mechanical ventilation
(i.e., assisted ventilation) is a method to
mechanically assist or replace
spontaneous breathing for people who
cannot breathe on their own.
Mechanical ventilation can be delivered
noninvasively through a face or nasal
mask or invasively with the involvement
of an instrument penetrating through
the mouth (e.g. endotracheal tube) or
the skin (e.g., tracheostomy tube).
Depending on a person’s needs,
mechanical ventilation may be short‐
term or long‐term. Short‐term
mechanical ventilation occurs generally in
a hospital ICU setting for an acute illness
or injury until a person is able to breathe
unassisted. Long‐term mechanical
ventilation may be
of one’s life for those with
neuromuscular, musculoskeletal, and/or
another type of condition or disease that
affects the use of respiratory muscles or
has involvement with the airways.
A ventilator is equipment used to
mechanically assist breathing by
transporting air to the lungs. There are
smaller, portable ventilators for use in
the home setting.
Coding Clinic Advice
Per AHA Coding Clinic 2008, Q1, “BiPAP
involves assisted ventilatory support,
which is designed to augment a patient's
ability to breathe on a spontaneous basis.
The patient is breathing on his own with
BiPAP or CPAP. Although CPAP and BiPAP
are similar, BiPAP provides continuous
positive airway pressure that is higher
when the patient breathes in and lowers
when the patient breathes out. In both
cases the patient is initiating his own
inspirations and exhalations. Both CPAP
and BiPAP are forms of respiratory
the assistance that augments the patient's
breathing. In contrast, mechanical
ventilation pumps air into the lungs even
when there is no attempt by the patient
to breathe independently.”
Coding Reference Status codes Z99.81 (no HCC) for supplemental oxygen are used to report patients on long‐term oxygen therapy, regardless of the duration of use each day.
This status code assignment applies to long‐term oxygen therapy consisting of dependence on ambulatory, continuous, supplemental, and/or nocturnal oxygen therapy. 34 Status code categories Z99.1 (HCC 82) are for use when the patient is dependent on a respirator (ventilator). This code category also includes weaning from a mechanical ventilator and encounters with respiratory (ventilator) dependence during power failure. For weaning from a mechanical ventilator, ICD‐10 coding guidelines state to assign a code from subcategory J96.1 (HCC 84), Chronic respiratory failure, with secondary status code Z99.11 (HCC 82), Dependence on respiratory [ventilator] status. Status codes are for use only when there are no complications or malfunctions of the device.
Ventilator-associated pneumonia (VAP) is a hospital-acquired (nosocomial) condition developing more than 48 hours after the introduction of mechanical ventilation.
Many patients who survive VAP encounter problems while being weaned from the ventilator, thereby developing chronic ventilator dependence.
Ventilator associated Pneumonia
1) Documentation of Ventilator associated Pneumonia
As with all procedural or postprocedural complications, code assignment
is based on the provider’s documentation of the relationship between the
condition and the procedure.
Code J95.851, Ventilator associated pneumonia, should be assigned only
when the provider has documented ventilator associated pneumonia
(VAP). An additional code to identify the organism (e.g., Pseudomonas
aeruginosa, code B96.5) should also be assigned. Do not assign an
additional code from categories J12-J18 to identify the type of
pneumonia.
Code J95.851 should not be assigned for cases where the patient has
pneumonia and is on a mechanical ventilator and the provider has not
specifically stated that the pneumonia is ventilator-associated
pneumonia. If the documentation is unclear as to whether the patient has
a pneumonia that is a complication attributable to the mechanical
ventilator, query the provider.
2) Ventilator-associated Pneumonia Develops after Admission
A patient may be admitted with one type of pneumonia (e.g., code J13,
Pneumonia due to Streptococcus pneumonia) and subsequently develop
VAP. In this instance, the principal diagnosis would be the appropriate
code from categories J12-J18 for the pneumonia diagnosed at the time of
admission. Code J95.851, Ventilator associated pneumonia, would be
assigned as an additional diagnosis when the provider has also
documented the presence of ventilator associated pneumonia.