AHA Coding Clinic® for ICD-9 - 2008 Issue 1; Clarifications

Acute Respiratory Failure and Aspiration Pneumonia

When acute respiratory failure is present on admission along with aspiration or bacterial pneumonia and both conditions are equally treated can either condition be sequenced as the principal diagnosis? Updated coding guidelines for acute respiratory failure were published in Coding Clinic First Quarter 2005, pages 3-8, which superseded previously published advice. However, information published in Coding Clinic Second Quarter 2003, pages 21-22, stating respiratory failure and pneumonia are not co-equal was not rescinded. Since this has caused a great deal of confusion in the field please clarify. For example, a 90-year-old nursing home resident was admitted to the hospital with shortness of breath, elevated white blood cell count, and bibasilar infiltrates. The provider diagnosed aspiration pneumonia and acute respiratory failure and both conditions were present on admission. Intravenous antibiotics were administered, oxygen therapy was provided and her clinical condition improved. Due to the possibility of chronic obstructive pulmonary disease (COPD), she was started on Advair. After the patient experienced a few runs of paroxysmal supraventricular tachycardia, Metoprolol therapy was initiated. The patient was transferred to the SNF in stable condition following an uneventful hospital course. Which diagnosis should be sequenced as the principal diagnosis, aspiration pneumonia or acute respiratory failure? ...

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