Q&A: RDS clarification and education

Q: Our providers tend to use the term “RDS” in their documentation to describe all “respiratory distress,” “respiratory distress syndrome of newborn,” and “acute respiratory failure.” Often, we find ourselves querying to clarify/remove RDS when it is in fact respiratory distress and not respiratory distress syndrome of newborn. While this helps with denial prevention, it is a negative query impact. What education do you recommend to help the providers differentiate between the diagnoses?

A: First, talk to your neonatal doctors and get all of their definitions of “RDS.” See how that compares with evidence-based definitions. Are they using “RDS” for transient tachypnea? For each case, also make sure to determine if you’re talking about pre-term or full-term infants; many infants will have mild RDS and not require surfactant.

Once you speak with everyone to see what their definition is, then you have a starting point to write a standard organizationwide RDS definition that all of the providers can use. Work with them as a group or one-on-one for education to get all providers on the same page about what the definition of RDS should be in their documentation.

As far as a negative impact query, it can be viewed as more of a compliance metric. These are the types of queries that prove CDI is not just there for the purpose of reimbursement. There may be numerous times each week that you have to query to verify if the diagnosis was ruled out or ruled in. This can generally lead to a lower weighted DRG, but that’s what’s compliant.

Editor’s note: This question and answer were adapted from a thread on the ACDIS Forum. To learn more about participating on the Forum, click here.