New pediatric respiratory failure white paper published for CDI specialists

By Brian Murphy

 

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 very 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 a forthcoming part 2.

 

ACDIS white papers are for members only, but I’ve included a 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 refine and validate their own internal criteria. Per ACDIS/APCA:

 

“Given that no organizations have put forth a universal consensus of diagnostic criteria to support the presence of acute respiratory failure in the pediatric population, this white paper was written to assist organizations in validating and refining their existing institutional definitions. If possible, the authors suggest organizations develop organizational consensus definitions using agreed-upon diagnostic criteria with appropriate consideration for the patient population.”

 

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). Here’s some helpful information on acute respiratory failure:

 

“Specificity of acute respiratory failure is based on identification of the presence of hypoxemia and/or hypercapnia:  

 

• 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%, oxygen (oxygenation) index ≤ 25, or P/F ratio < 300 with normal Hb, acutely and in the appropriate clinical context  

 

• Acute hypercapnic respiratory failure is defined as an acute increase of 10–15 mmHg from normal range of 35–45 with pH < 7.32, acutely and in the appropriate clinical context”

 

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 transparent diagnostic criteria to level the playing field and play with a common set of rules remains to be seen. But I applaud the effort.

 

Reference

 

• ACDIS, “Developing Pediatric Respiratory Failure Definitions”: https://acdis.org/resources/developing-pediatric-respiratory-failure-definitions