CCDS Respiratory Failure & Vents 2

Question 1

Which ICD-10-CM code distinguishes acute hypoxic respiratory failure from acute hypercapnic respiratory failure?

Accepted Answer

J96.01 versus J96.02

Answer

J96.00 versus J96.01

Answer

J96.00 versus J96.10

Answer

J96.01 versus J96.11

Question 2

A patient on mechanical ventilation has a tracheostomy placed on day 5 of ventilation. The patient continues on the vent for a total of 14 days before being weaned. Which ICD-10-PCS codes are required?

Accepted Answer

Codes for both the tracheostomy procedure and mechanical ventilation performance

Answer

One code for tracheostomy only; mechanical ventilation is a nursing procedure not coded in PCS

Answer

One code for extended mechanical ventilation; tracheostomy is included in the vent code

Answer

No PCS codes are needed; mechanical ventilation is coded only through diagnosis codes

Question 3

A physician documents 'respiratory insufficiency' for a patient on 3L nasal cannula. A CDI specialist considers querying for respiratory failure. What clinical threshold is commonly referenced to distinguish insufficiency from failure?

Accepted Answer

PaO2 below 60 mmHg or PaCO2 above 50 mmHg (acute), indicating inability to maintain adequate gas exchange

Answer

PaO2 below 80 mmHg on room air

Answer

SpO2 below 94% on room air regardless of supplemental oxygen

Answer

Respiratory rate above 20 breaths per minute requiring supplemental oxygen

Question 4

Acute-on-chronic respiratory failure (J96.2x) as a secondary diagnosis is classified as which CC/MCC level?

Accepted Answer

MCC (Major Complication or Comorbidity)

Answer

Non-CC (no DRG impact)

Answer

CC (Complication or Comorbidity)

Answer

Context-dependent, varying by principal diagnosis MDC

Question 5

Which ventilator mode is associated with ARDS management and involves using low tidal volumes to prevent ventilator-induced lung injury?

Accepted Answer

Lung-protective ventilation (ARDSNet protocol) with tidal volumes of 6 mL/kg of predicted body weight

Answer

Assist-Control (AC) with standard tidal volumes of 10-12 mL/kg

Answer

High-frequency oscillatory ventilation (HFOV) as the primary ARDS mode

Answer

Pressure Support Ventilation (PSV) with spontaneous breathing trials from day 1

Question 6

When a patient requires non-invasive positive pressure ventilation (BiPAP) but does NOT require mechanical ventilation via endotracheal tube, how is this coded in ICD-10-PCS?

Accepted Answer

5A09357 - Assistance with respiratory ventilation, continuous positive airway pressure

Answer

5A19354 - Respiratory ventilation, less than 24 hours, non-invasive

Answer

No ICD-10-PCS code is assigned for non-invasive respiratory support

Answer

A diagnosis code for respiratory failure is sufficient without a procedure code