Respiratory Question for the Week of July 23, 2018

Question:

When Is respiratory failure a principal or secondary diagnosis?

Answer:

When the patient is admitted with acute respiratory failure and another acute condition, both equally responsible for necessitating the admission, and when there is no chapter-specific sequencing rules, it is appropriate to code either as the principal diagnosis based on the circumstances.

For example, if the co-existing acute condition is diastolic congestive heart failure and the patient responds to immediate IV diuresis and oxygen support, the circumstances of this case suggest that acute respiratory failure is a result of pulmonary volume overload. Chapter-specific coding guidelines also state that—in cases of obstetrics, poisoning, HIV, sepsis and newborns—the respiratory failure would then become a secondary diagnosis. Also, chronic respiratory failure should never be your principal diagnosis (as it is a chronic condition, not acute and not likely to necessitate an inpatient admission except in rare circumstances).