ACDIS tip: NEJM offers insight into clinical indicators for supplemental oxygen delivery

With more than a million respiratory failure discharges annually, CDI professionals need to consistently refresh their clinical and coding knowledge to compose effective queries.  New information related to the use of supplemental oxygen for hospitalized adults, including a chart relating to the devices used in supplemental oxygen therapy and the clinical indicators, was released in the July 15 edition of The New England Journal of Medicine (NEJM).

Several approaches to the administration of supplemental oxygen including nasal cannula and high-flow nasal cannula, face mask and nonrebreather face mask, as well as Venturi mask, were addressed in the article offering CDI professionals a refresher on the fraction of inspired oxygen (FiO2) related to each delivery method, explained William E. Haik, MD, FCCP, CDIP, of DRG Review Inc., in Fort Walton Beach, Florida, in his webinar on Deep Breaths: Tools to Decipher Documentation & Reporting for Respiratory Failure/Insufficiency which took place Thursday, July 29.

An increase in minute ventilation, or mouth breathing, can dilute the oxygen and lower the FiO2, the NEJM article states, so low-flow delivery systems “do not provide very accurate estimates” compared to ventilation.

In his webinar, Haik reminded listeners that respiratory failure is a condition categorized by inadequate exchange of oxygen and/or carbon dioxide by the lungs. It’s a life-threatening disorder requiring aggressive management and monitoring.  A patient with acute respiratory failure usually exhibits evidence of increased work of breathing (rapid respiratory rate, use of accessory muscles of respiration) or possibly cyanosis and/or paradoxical breathing.

Importantly, Haik notes, that treatment includes frequent respiratory therapy and possibly support with either invasive mechanical ventilation or non-invasive modalities such as CPAP/BiPAP and/or high-flow oxygen therapy, however, the absence of mechanical ventilation does not exclude the diagnosis of acute respiratory failure.

In order for the diagnosis of acute respiratory failure to be supported as a principal diagnosis, documentation should include aggressive monitoring such as within the ICU or PCU, telemetry or continuous oxygen monitoring as well as aggressive treatment with CPAP/BiPAP, high-flow nasal cannula, or mechanical ventilation, Haik explained.

Editor’s note: An on-demand version of Deep Breaths: Tools to Decipher Documentation & Reporting for Respiratory Failure/Insufficiency can be found here.