Diseases of the Respiratory System

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Diseases of the Respiratory System

• Chapter 15

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Pneumonia

• Refer to the laboratory report for mention of a
  causative organism and verify with the physician.

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Lobar Pneumonia

• Lobar Pneumonia does NOT REFER to the ACTUAL LOBE
  INVOLED! Instead it refers to a particular TYPE
  of pneumonia, usually caused by Strep.

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Gram-Negative Pneumonia

• May appear as a complication of surgery, trauma,
  chronic illness or COPD
• See the common symptoms in text
• Remember only the physician can make the
  diagnosis

5

• Review sections on Aspiration Pneumonia and
  Supraglottitis

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Chronic Obstructive Pulmonary Disease

• General term used to describe a variety of
  conditions
• Chronic Obstructive Asthma
• Chronic Obstructive Bronchitis
• Emphysema
• Chronic Bronchitis with Emphysema

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Coding COPD

• Note When the diagnosis is stated only as COPD,
  review the medical record to determine whether a
  more definitive diagnosis is documented.

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• Code 496, Chronic Obstruction, not elsewhere
  classified, is assigned only when no more
  specific code can be assigned.

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Asthma

• 5th digits indicate status asthmaticus

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• Some terms used to describe Status Asmaticus
  include
• Intractable Asthma
• Refractory Asthma
• Airway Obstruction not relieved by
  bronchodilators
• Severe prolonged asthma

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• Code as status asthmaticus if there is
  documentation from the physician

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Bronchospasm

• Note Bronchospasm is an integral part of asthma
  or any other type of chronic airway obstruction,
  so NO additional code is assigned to indicate its
  presence.

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Atelectasis

• Atelectasis reduces ventilatory function.
• Is an integral part of pulmonary disease

14

• Code 518.0, Pulmonary collapse, should not be
  assigned on the basis of X-ray findings alone!

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Pleural Effusion

• Pleural Effusion is an abnormal accumulation of
  fluid with in the pleural spaces.

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• It is almost always integral to the underlying
  disease (i.e.CHF), and is usually addressed only
  by the treatment of the underlying disease.
• In this instance, the effusion would not be coded
  as a secondary diagnosis

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• In other cases, it may be necessary to address
  the effusion separately with thoracentesis or
  chest tube drainage.
• In these cases, the effusion would be coded as a
  secondary diagnosis

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• Note Pleural Effusion can be coded as a
  principal diagnosis only when treatment is
  addressed solely at the pleural effusion

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Respiratory Failure (RF)

• RF must be documented by the physician

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• Respiratory Failure can be coded as a principal
  diagnosis or as an secondary diagnosis.

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When is RF coded as a principal diagnosis?

• When the RF is due to or associated with an
  underlying respiratory condition.
• The RF is due to or associated with a chronic
  non-respiratory condition.

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When is RF coded as a secondary diagnosis?

• When the RF is due to or associated with an acute
  non-respiratory condition.
• When the RF is due to or associated with an acute
  exacerbation of a chronic non-respiratory
  condition.

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Acute Pulmonary Edema

• Acute pulmonary edema is an accumulation of fluid
  in the tissues and the alveolar spaces of the
  lung.

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• Can be divided into two categories Cardiogenic
  and Noncardiogenic

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• Cardiogenic Acute pulmonary edema due to
  congestive heart failure

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• Noncardiogenic
• Post-radiation
• External irritants
• Drug overdose

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Coding Intubation for Mechanical Ventilation

• Intubation should be reported when the intubation
  or tracheostomy is performed after admission or
  in the ER of the same hospital immediately before
  admission.

• Intubation should NOT be reported when the
  intubation or tracheostomy is carried out
  elsewhere prior to admission, or in an ambulance
  prior to arrival at the hospital.

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Mechanical Ventilation

• Codes for mechanical ventilation indicate whether
  the patient was on the ventilator for more than
  or less than 96 consecutive hours.

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When to start counting hours for Ventilation

• When endotracheal intubation is performed,
  followed by initiation of mechanical ventilation.
• Initiation of mechanical ventilation through
  tracheostomy performed in hospital.
• Admission of patient who is already on mechanical
  ventilation.

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Continue counting mechanical ventilation

• When replacing endotracheal tube.
• When a patient on mechanical ventilation must
  later receive a tracheostomy.
• When a patient is weaned from ventilator.

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Mechanical Ventilation ends with one of the
following

• Removal of the endotracheal tube.
• Discontinuance of ventilation for patients with
  trachostomy after weaning period is complete.
• Discharge or transfer while still on mechanical
  ventilation.

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Mechanical ventilation (cont.)

• Note Sometimes a patient who had been on
  ventilation earlier in the hospital stay
  deteriorates and a subsequent period of
  mechanical ventilation may be required.
• In this case, two codes for mechanical
  ventilation are required one for each time.