Anesthesia Coding Alert

Plus: Watch whether the patient’s condition merits a higher P status modifier. 

When your anesthesia provider is present during surgery for a patient with acute exacerbation on chronic respiratory failure, an accurate diagnosis is important for documentation’s sake – and might also boost your bottom line. 

ICD-9: Currently, you report acute exacerbation on chronic respiratory failure with 518.84 (Acute and chronic respiratory failure). If the respiratory failure is identified to be caused by an infectious organism, you will have to additionally code the causative organism using another ICD-9 code.

Caution: If the respiratory failure has occurred due to trauma or surgery, don’t report diagnosis 518.84. Instead, report the patient’s condition with 518.53 (Acute and chronic respiratory failure following trauma and surgery). Also, 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 changes: When physicians 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 access the surgeon’s chart to see whether he identified hypercapnia or hypoxia during diagnostic tests.

Based on the presence of hypoxia or hypercapnia, J96.2 adds a fifth digit to expand as the following three codes:

• 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 your 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).

Physical status: You might be able to report a higher-level patient status modifier with the claim, depending on how serious the patient’s condition is. For example, documentation might support submitting P3 (A patient with severe systemic disease). Although additional payment associated with P modifiers isn’t guaranteed, some payers recognize and reimburse for the additional risk of treating these patients.