Q:  Should hospital acquired conditions be assigned code Y95 for nosocomial infection or only using the present on admission (POA) indicators?
A:  Assign code Y95 for nosocomial infection. This code encompasses both hospital and healthcare-acquired conditions, including those acquired outside of the current facility. Use the POA indicator field for code Y95 to indicate whether the nosocomial infection existed before admission or developed during the current encounter.

Q:  How is acute exacerbation of emphysema coded?
A:  Assign code J43.9, Emphysema, for COPD with emphysema without mention of chronic bronchitis. While chronic bronchitis with COPD and emphysema is classified to category J44, chronic bronchitis is not synonymous with COPD. Since emphysema is a type of COPD, it is coded rather than a generic COPD code from category J44.

Q:  How does specificity in respiratory failure coding impact MS-DRG assignment?
A:  Accurate documentation and coding of respiratory failure impacts MS-DRG assignment. While chronic respiratory failure codes (hypoxic, hypercapnic, and unspecified) are CCs, acute and unspecified respiratory failure codes are MCCs. This presents a potential compliance risk if the coder assigns a code for unspecified respiratory failure (an MCC) when chronic respiratory failure (a CC) is documented. Clinical documentation improvement (CDI) programs can assist providers in identifying the chronicity of respiratory failure based on clinical indicators.

Q:  How do you code COPD with bronchitis that is not specified as acute or chronic?
A:  The indexing assumes a cause and effect relationship between the COPD and bronchitis and a single code from category J44 is assigned.  The “With” coding convention is employed in this situation.

Q:  Sequencing depends on the circumstances of admission, but when there are multiple respiratory conditions, it is not always clear if all of the conditions were present on admission.  How do we sequence when that is unclear?
A:  If you are not sure if a condition was present on admission, query the provider for clarification.