This page addresses follow-up questions and additional information pertinent to our webinar
CDI Strategies for the Respiratory System.

** The coding information and guidance are valid at the time of publishing. Learners are encouraged to research
subsequent official guidance in the areas associated with the topic as they can change rapidly.

Q: When might acute pulmonary insufficiency be considered and why is it important to distinguish it from acute respiratory failure?
A: Acute pulmonary insufficiency may be considered when the patient has a less severe respiratory condition that does not meet criteria for acute respiratory failure. For example, after initially weaning from oxygen, the patient may require supplemental oxygen again, without another definitive diagnosis such as COPD exacerbation or CHF exacerbation.

Although both may affect coding, acute respiratory failure reflects a more severe condition. CDI should ensure the provider’s documentation accurately reflects the patient’s clinical status and treatment needs.

Q: Why is mechanical ventilation time important?
A: Ventilation duration affects procedure coding and DRG assignment. CDI should verify whether the duration is less than 24 hours, 24 to 96 hours, or greater than 96 hours. The start time depends on the clinical circumstances, such as when the endotracheal tube is placed and ventilation begins, or the time of admission order if the patient arrives already ventilated.

Q: What makes a respiratory query compliant?
A: A compliant query includes relevant clinical indicators, avoids leading the provider, offers reasonable answer choices, and allows the provider to use clinical judgment. It should include options such as a specific diagnosis, diagnosis ruled out, unable to determine, or other with free-text clarification.