I enhance and elevate careers of mid-revenue cycle healthcare professionals. Published author, podcast host. Former ACDIS Director.
Pediatric clinicians (of which I’m definitely not one, but I listen well) will frequently tell you: Children are not just little adults. That goes for clinical criteria used to diagnose pediatric conditions, and associated CDI and coding work. And in particular, respiratory failure. I was glad to see ACDIS and the American College of Physician Advisors (ACPA) collaborate on an important new white paper, “Developing Pediatric Respiratory Failure Criteria.” The paper is part 1 of a two-part series addressing respiratory failure in both pediatric and neonatal populations. Part 1 focuses on the pediatric population (patients older than 28 days and younger than 18 years). Neonatal patients will be covered in part 2. Normally ACDIS white papers are for members, but non-members can access it through Nov. 8. See link below. While the paper offers clinical information and definitions, it does not offer a formula for wholesale adoption. Rather, its purpose is to help healthcare organizations develop, refine, and validate their own internal criteria. The paper does offer some helpful baseline criteria. From the paper: 💡 “Respiratory failure is the inability of the respiratory system to meet the body’s oxygenation, ventilation, and/or metabolic requirements. It is important to know the values and presentations that are considered to be within the defined limits of each patient population. Any underlying condition, process, or trauma that interferes with oxygenation or ventilation can result in respiratory failure.” It then adds context for the pediatric population, listing examples of cardiopulmonary diseases, infections, neurologic disorders, traumas, and complications secondary to medical interventions. These are worth reviewing for any CDI or coding professional as the basis for compliant query. It also covers acute, chronic, and acute on chronic respiratory failure, as well as its three types (hypoxic, hypercapnic, combined). Perhaps most useful is discussion on clinical signs, symptoms and diagnostics, which should prove helpful for clinical validation of a respiratory failure diagnosis—potentially staving off payer denials. Per the paper: 💡 “Documentation should include indicators such as: Tachypnea, bradypnea, retractions (e.g., intercostal, subcostal, suprasternal), head bobbing, nasal flaring, grunting, cyanosis, diaphragmatic breathing, diaphoresis, lethargy, confusion, difficulty feeding, tripoding/posturing/ extended airway, wheezing, stridor, crackles (fine/coarse), diminished paradoxical movement, flail chest, tachycardia, bradycardia, hypoglycemia, acidosis (respiratory/metabolic).” Whether “the dark half” (i.e., payers) adopt similar diagnostic criteria to level the playing field and play with a common set of rules remains to be seen. But I applaud the effort. Have you read the paper? Does your organization struggle with pediatric respiratory failure (if you even have a pediatric CDI program)? Leave a comment below.
Thanks for highlighting this Brian. Resp failure is far and away the number one query at every hospital we consult at. I think the paper is great except this statement: "Acute hypoxic respiratory failure is defined as PaO2 < 60 mmHg, SaO2 <88%–90% on room air, oxygen needs of 30% or greater to maintain SaO2 > 90%" I agree with the <88-90% (hospital dependent) but the 30% use of oxygen is not based on science or accepted standard from any pediatric organization. Exactly how much oxygen a patient is getting isn't even clear when on nasal cannula or face mask. There are some guidelines people use that discuss each LPM (liter per minute) being X% of oxygen, but most pulmonologists don't agree with those numbers. So does a child need to be on 2-3 LPM of oxygen to qualify for resp failure? Absolutely not. Any amount of oxygen needed to maintain saturations > 88-90% plus acute resp symptoms should qualify for "acute resp failure" according to the many children's hospitals that my team represents. I don't want hospitals to limit their use of this diagnosis/query based on that 30% (2-3 LPM) criteria in this paper.
I enhance and elevate careers of mid-revenue cycle healthcare professionals. Published author, podcast host. Former ACDIS Director.
2moACDIS, “Developing Pediatric Respiratory Failure Definitions”: https://acdis.org/resources/developing-pediatric-respiratory-failure-definitions