Cracking the Code

Acute Respiratory Failure as Principal Diagnosis

Acute respiratory failure occurs when fluid builds up in the air sacs in the lungs. During this occurrence, lungs are unable to release oxygen into the blood. In return, the organ cannot get enough oxygen-rich blood to function properly. With a lot of medical scenarios, it is common to see acute respiratory failure listed as a secondary diagnosis; however, there are some cases where this condition can be sequenced as the principal diagnosis. Acute respiratory failure can be coded as the principal diagnosis if it meets the definition and is clinically supported in the medical record. It all boils down to the circumstances of admission, any diagnostic workup and/or therapy provided, and whether there are any coding conventions or guidelines that give direction to code otherwise.

Q: A 57-year-old patient presents to the emergency department with acute hypoxic respiratory failure and was admitted as inpatient status with pulseless electrical activity (PEA) cardiac arrest. The patient was also hypoglycemic with a low blood glucose level of 32. During the hospital course, the patient is admitted to the intensive care unit on mechanical ventilation. Final discharge diagnoses: PEA cardiac arrest possibly due to hypoglycemia and acute respiratory failure post arrest and heart failure. What is the primary diagnosis for this encounter?
A: J96.01, acute respiratory failure with hypoxia
Reference: AHA Coding Clinic Fourth Quarter 2013 page 121: Smoke inhalation and acute respiratory failure
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