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Misc CCS Info

Terms in this set (5)

There are three fundamental coding guidelines related to respiratory failure sequencing when the diagnosis is related to a non-respiratory condition:

1. When a patient is admitted in respiratory failure due to or associated with an acute non-respiratory condition, the acute condition is sequenced as the principal diagnosis.

For example: A patient experienced a cerebrovascular thrombosis with infarction, and upon arrival at the ER was found to be in respiratory failure. The patient was placed on mechanical ventilation and admitted to the ICU for further care for the respiratory failure and management of the cerebrovascular thrombosis/infarction.

Principal diagnosis: 434.01 Cerebral thrombosis with infarction

Secondary diagnosis: 518.81 Respiratory failure

In this example, the acute cerebrovascular thrombosis required admission and is the principal diagnosis; the respiratory failure required immediate treatment but was a complication of the cerebral thrombosis.

2. When a patient is admitted with acute respiratory failure due to or associated with an acute exacerbation of a chronic non-respiratory condition, the acute condition is sequenced as the principal diagnosis.

For example: Following dietary indiscretion, a patient with compensated congestive heart failure (CHF) developed paroxysmal nocturnal dyspnea, orthopnea and pedal edema leading to increased respiratory distress. In the ER, the patient was found to be in cardiogenic pulmonary edema and respiratory failure and was subsequently intubated in the ER. The patient was admitted and treated for congestive failure.

Principal diagnosis: 428.0 Congestive heart failure

Secondary diagnosis: 518.81 Respiratory failure

The CHF had become acute and required immediate hospital care. The associated development of respiratory failure in this case is an additional complicating factor, but is not the condition that occasioned the admission and should not be sequenced as the principal diagnosis.