Q&A: Queries for flash pulmonary edema

Q: Under what circumstances and when is it appropriate to code flash (acute) pulmonary edema and acute-on-chronic heart failure (diastolic or systolic or other)? Would we need to query for both as flash (acute) pulmonary edema unrelated to acute/chronic heart failure? Considering the following possibilities:

• Established diagnosis of heart failure and methamphetamine intoxication
• Established diagnosis of heart failure and smoke inhalation or carboxyhemoglobinemia
• Established diagnosis of heart failure and what other conditions

A: Documentation of FLASH pulmonary edema would require a query as this is not an inclusion term for acute pulmonary edema. The provider would need to state acute pulmonary edema to allow reporting.

By way of your question, you understand that pulmonary edema is considered integral to heart failure and the two would not be reported together in normal circumstances. But if the etiology of the pulmonary edema is identified as not related to heart failure then it could be reported.

You provided a few examples in which the etiology of the pulmonary edema is not due to heart failure. For example, if the provider describes acute pulmonary edema related to methamphetamine intoxication it would be reported as such. The key would be the pulmonary edema is identified as not being cardiogenic.

I do understand this is a difficult needle to thread as the conditions you have listed can contribute to heart failure. I would suggest you explore with your providers the nature of the failure. Heart failure is a chronic condition that can flare or exacerbate. In your example of smoke inhalation or carboxyhemoglobinemia, the pulmonary edema is acute and related to an emergent insult (non-cardiogenic).

Editor’s Note: Laurie Prescott, RN, MSN, CCDS, CCDS-O, CDIP, CRC, CDI education director at HCPro, answered this question. For information regarding CDI Boot Camps, click here.