Cracking the Code

Coding Respiratory Failure

What is respiratory failure? ‘Respiratory failure is a life-threatening condition that is always due to an underlying condition. It may be the final pathway of a disease process or a combination of different processes. Respiratory failure can result from either acute or chronic diseases that cause airway obstruction, parenchymal infiltration, or pulmonary edema. It can arise from an abnormality in any of the components of the respiratory system, central nervous system, peripheral nervous system, respiratory muscles, and chest wall muscles. The diagnosis is based largely on findings from arterial blood gas analysis, which vary from individual to individual, depending on several factors. Never assume a diagnosis of respiratory failure without a documented diagnosis by the physician.’ The codes for respiratory failure are selected by acute, chronic, and unspecified and if there is the presence of hypoxia or hypercapnia. The sequencing of acute respiratory failure is based on the reason for the encounter. If a patient is admitted for acute respiratory failure, a code from subcategory J96.0, Acute respiratory failure, or J96.2, Acute and chronic respiratory failure are sequenced first. If the patient is admitted for various reasons, choose the condition that requires the most care.

Q: When do you code acute respiratory failure as a secondary diagnosis?
A: When it occurs after admission Rationale: According to ICD-10-CM guideline I.C.10.b.2, respiratory failure may be listed as a secondary diagnosis if it occurs after admission, or if it is present on admission, but does not meet the definition of principal diagnosis
Reference: AHA Coding Handbook
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