Anesthesia Coding Alert

Question: Which diagnosis codes support the use of anesthesia when caring for postoperative patients with respiratory problems? We normally use 518.5 (Pulmonary insufficiency following trauma and surgery) for patients who are still intubated and vented, and thereafter when they are receiving oxygen. When is diagnosis code 997.3 (Respiratory complications resulting from a procedure) appropriate? Is it reserved for complications such as aspiration under anesthesia? A co-worker specifically asked about two patients who are recovering from tonsil and adenoids (T&A) surgery and have extrathoracic gasway obstruction.

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Answer: When a patient is left ventilated for a few hours in the recovery room as a routine part of surgery, the ventilation is probably included in the global anesthesia fee. When the patient is ventilated before surgery, then the fact that he is vented after surgery is due to a pre-existing condition, not the surgery.

If the patient is unable to be weaned from the ventilator during the normal postoperative period and the anesthesiologist assumes responsibility for the patient's respiratory status, code 518.5 is a reasonable diagnosis to support the kind of care provided. Two other possibilities are 518.81 (Other diseases of lung; acute respiratory failure) and V46.1 (Other dependence on machines; respirator).

In my opinion, 997.3 indicates that the procedure (whether it's being performed or has been completed) caused the respiratory problem. Part of the dilemma is deciding exactly what constitutes "respiratory complications resulting from a procedure," which could apply to a myriad of things. I would use 997.3 for the T&A patients in question.

You Be the Coder and Reader Questions were reviewed by Donna Howe, anesthesia coder for the physician group Anesthesiology Associates of Eastern Connecticut in Manchester.