APR DRG of the Week: APR-DRG 133: Pulmonary Edema and Respiratory Failure

Change the Principal diagnosis

       Alternate principal diagnoses recommended by FairCode docs include ...

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  •  
    • 491.21   COPD with exacerbation                                               →  DRG 140
    • 428.0     Congestive heart failure                                                 →  DRG 194
    • 162.2     Cancer of lung                                                                →  DRG 136
    • 486          Pneumonia                                                                    →  DRG 196

Add a Secondary diagnosis

• Electrolyte disorders: 276.2 Acidosis
• Cardiovascular disorders: 428.0 Congestive heart failure, 425.4 Cardiomyopathy, 427.1 Ventricular tachycardia
• Respiratory disorders: 511.9 Pleural effusion, 486 Pneumonia, 507.0 Aspiration pneumonia V46.2 Dependence on supplemental Oxygen, 518.1 Pneumomediastinum
• Endocrine disorders: 250.02 Diabetes, uncontrolled, 278.01 Morbid obesity V85.4 BMI over 40, 799.4 Cachexia
• Renal disorders: 591 Hydronephrosis, 788.20 Urinary retention, 584.9 Acute renal failure
• Hematologic disorders: 287.5 Thrombocytopenia

Add a Procedure

• 96.71     Continuous mechanical ventilation <96 hours                           →  May Increase SOI

Discussion

• Coding Clinic First Quarter 2005 advises, "If a patient is admitted for both respiratory failure and another acute condition, either condition may be listed as principal. ...  Selection of the principal diagnosis will depend on the circumstances of admission. If two or more diagnoses equally meet criteria for principal diagnosis, either one can be selected."  Look carefully at the circumstances of admission to see two or more approximately co-equal conditions meet the criteria for principal diagnosis.
  • Coding Clinic First Quarter 2005 adds that respiratory failure is reported as a secondary diagnosis (not PDx) when the patient is admitted with sepsis, neoplasms, pregnancy, and poisoning.
• Remember to check the nurses' notes or respiratory flow sheets for mechanical ventilation.  Count the hours.  Re-read the guidelines for counting the hours of mechanical ventilation - weaning counts!