Respiratory Failure & Vents Flashcards

A patient with acute exacerbation of COPD is placed on BiPAP in the ED and admitted to the ICU. Arterial blood gas shows pH 7.28, PaCO2 58, PaO2 54. Which diagnoses should be queried for in this scenario?

Answer: Acute-on-chronic respiratory failure (hypercapnic) and COPD exacerbation

The ABG values (pH 7.28, PaCO2 58, PaO2 54) indicate hypercapnic failure in a COPD patient, representing acute-on-chronic respiratory failure. CDI should query for both COPD exacerbation and acute-on-chronic respiratory failure.

A CDI specialist reviews a case where a patient is extubated successfully on day 3 of mechanical ventilation. The physician documents 'respiratory failure, resolved.' The CDI specialist should:

Answer: Query to specify the type and chronicity (acute hypoxic, hypercapnic, or acute-on-chronic)

Even though respiratory failure resolved, it was an active, significant diagnosis during the stay that required mechanical ventilation. CDI should query for specificity (hypoxic versus hypercapnic, acute versus acute-on-chronic) because the specific code carries MCC designation. Resolved conditions that affected care during the stay are coded.

Ventilator-associated pneumonia (VAP) requires documentation of which minimum timeframe on mechanical ventilation before pneumonia onset?

Answer: Pneumonia developing more than 48 hours after initiation of mechanical ventilation

VAP is defined by CDC and clinical criteria as pneumonia developing more than 48 hours after mechanical ventilation was initiated.

In ICD-10-PCS, which structural feature distinguishes Section 5 ventilation codes from Section 0 medical and surgical codes?

Answer: Section 5 uses Duration and Function characters instead of a standard Approach character

Mechanical ventilation codes in ICD-10-PCS Section 5 use Duration and Function characters in positions where Section 0 codes use Body Part, Approach, and Device characters. There is no standard Approach character in Section 5 respiratory ventilation codes.

A CDI specialist notices that a patient with acute respiratory distress syndrome (ARDS) is documented only as 'bilateral pneumonia' by the attending. What clinical documentation would BEST support querying for ARDS?

Answer: Berlin criteria: acute onset within 7 days, bilateral infiltrates not fully explained by cardiac failure, and P/F ratio 300 or below despite PEEP at or above 5 cm H2O

The Berlin Definition of ARDS requires: acute onset within one week of clinical insult, bilateral opacities on imaging not fully explained by effusions/collapse/nodules, respiratory failure not fully explained by cardiac failure or fluid overload, and decreased P/F ratio with PEEP at or above 5 cmH2O.

Which clinical scenario BEST illustrates the difference between 'respiratory arrest' (R09.2) and 'acute respiratory failure' (J96.0x) in ICD-10-CM?

Answer: Respiratory arrest indicates complete cessation of breathing requiring resuscitation; acute failure indicates compromised gas exchange not necessarily requiring CPR

Respiratory arrest (R09.2) is used when a patient experiences complete cessation of breathing, typically requiring resuscitation. Acute respiratory failure (J96.0x) represents compromised gas exchange that does not necessarily involve complete cessation of breathing.