Q&A: A recap of the ACDIS Quarterly Conference Call

Editor’s Note: The ACDIS Quarterly Conference Call was held on November 19, and featured a roundtable discussion with 12 of our ACDIS Advisory Board members. The following questions were submitted by audience members after the call, and were answered by advisory board member, James P. Fee, MD, CCS, CCDS, Vice President at Enjoin.

Q: We are struggling with the definitions of acute respiratory failure and chronic respiratory failure issue. My clinicians are asking me for the clinical indicators. Any ideas where to turn? 

A: It is difficult to give a single source. Most medical textbooks define using arterial blood gases criteria and now some P/F ratios. However, true respiratory failure incorporates patient findings and symptoms, impaired oxygenation and ventilation, and intensity of treatment.

Q: I am wondering what the doctor has to say in order for the coder to take a fracture to the traumatic section. If the provider documents that the patient comes in with a “fracture from a fall,” and the patient doesn’t have a history of osteoporosis documented, can the coder take this to traumatic?

A: There are two separate entries in the code set Alphabetic Index: one for pathological and one for traumatic, at the same level. There is no default code in ICD-10, as in ICD-9, should the physician neglect to provide that additional detail, so the type of fracture must be specified. I recommend looking at the code book.

Q: In ICD-10, can you code chronic obstructive pulmonary disease (COPD) exacerbation with aspiration pneumonia?

A: There is no excludes 1 or 2 note under aspiration pneumonia (J69.0) or COPD with acute exacerbation (J44.1). Now there is a confusing note, under J44.0, to assign an additional code to identify the infection, but this would imply sequencing issues and really only applies to bronchitis or bronchiolitis (based on the instructional notes under those code categories).