Anesthesia Coding Alert

Code choices will hinge on presence of hypercapnia or hypoxia.

Treating patients who have chronic conditions can change how an anesthesiologist provides care in some circumstances, and might even allow for additional reimbursement. One example is a patient undergoing a procedure who has been diagnosed with acute exacerbation of chronic respiratory failure.

ICD-9: Currently, providers have three diagnosis choices in this situation, depending on the presence of hypercapnia or hypoxia from the results of blood gas analysis (which you’ll need to acquire from the surgeon or other physician).

For acute exacerbation of chronic respiratory failure, you report 518.84 (Acute and chronic respiratory failure). If the respiratory failure is identified to be caused by an infectious organism, you also report the causative organism using another ICD-9 code.

Reminder: If the respiratory failure has occurred due to trauma or surgery, you cannot use 518.84 to report the diagnosis. Instead, you will have to report this with 518.53 (Acute and chronic respiratory failure following trauma and surgery). Also, note that based on the descriptor, you should use 518.84 only if the diagnosis is acute on chronic respiratory failure. If the patient only has acute respiratory failure, you’ll report this with 518.81 (Acute respiratory failure).

ICD-10: When you make the transition to ICD-10 codes, you’ll report a diagnosis of acute on chronic respiratory failure with J96.2 (Acute and chronic respiratory failure). But, with ICD-10, you will need to further expand your reporting options based on whether the patient has type I or type II respiratory failure. You will need to look at the tests (arterial blood gases) performed to see if the physician has identified hypercapnia or hypoxia. Based on the presence of hypoxia or hypercapnia, J96.2 expands into the following three codes using a fifth digit:

• J96.20 (Acute and chronic respiratory failure, unspecified whether with hypoxia or hypercapnia)
  
• J96.21 (Acute andchronic respiratory failure with hypoxia)
  
• J96.22 (Acute and chronic respiratory failure with hypercapnia).
  

As in ICD-9, you cannot use these code sets if the clinician’s diagnosis is either acute or chronic respiratory failure. For these you will have to use J96.0- (Acute respiratory failure) and J96.1- (Chronic respiratory failure).