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Respiratory failure following a drug overdose, sequela or a manifestation?

Inpatient or observation coders for acute hospital settings may see a similar situation such as this one with chronic respiratory failure following drug overdose.  How do I know if it is a sequela or a manifestation?  Coders may find it difficult to know whether to follow the poisoning guidelines or not.  See the clarification from the coding clinic to determine the correct path.

A patient with chronic respiratory failure was transferred to LTAC for continuing care of the condition following an accidental drug overdose.  J96.10, Chronic respiratory failure, unspecified is coded as the principal diagnosis with the poisoning code as additional diagnosis.  The chronic respiratory failure is a sequela, so we would follow the guideline for sequela rather than the poisoning guideline.

Reference:  Coding Clinic, First Quarter ICD-10 2016 Pages: 38 Effective with discharges: March 18, 2016

Fiberoptic bronchoscopy with obtained brushings.

Do you code surgeries in your inpatient charts?  Maybe the information from this coding clinic will shed some light on coding multiple procedures.  Is it excision or drainage?  Or maybe both?

 A fiberoptic bronchoscopy was performed on the patient.  From the left upper lobe bronchus, brushings were obtained; the washings, bronchoalveolar lavage and brushing specimens were taken for exam. 

 Both the excision for the washings and brushing 0BB88ZX, and the drainage for the lavage 0B988ZX, would be coded.

Reference: Coding Clinic, First Quarter ICD-10 2016 Page: 27 Effective with discharges: March 28, 2016

 One of the best (and maybe worst) things about the coding profession is that there is always so much more to learn. The infinite nuances of various continuously changing coding guidelines combined with the wildcard variable of documentation, and evolving HIM technology give us no choice but to take the “never stop learning” philosophy especially seriously. Whether you are one of our coders or not, HCCS is here to help you in your pursuit of knowledge as you grow in your career. Through the Coding Canapés series of posts, we’ll regularly introduce and interpret official guidelines such as AHA’s Coding Clinic. We hope coders everywhere benefit from and even enjoy these posts. Bon Appétit!


Topics: Work From Home, Medical Coding, ICD-10, Coding Canapes, Health Information Management

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