Breathing air into ARDS: Understanding a common manifestation of COVID-19

March 10, 2021 / By Audrey Howard, RHIA, Sue Belley, RHIA

Since the start of the pandemic, health care professionals have focused on understanding acute respiratory distress syndrome (ARDS) as a manifestation of COVID-19. Although ARDS was first clinically recognized in the late 1960s, HIM and CDI professionals may have limited knowledge about the condition because it is documented infrequently in the health record. Since ARDS is included as a common respiratory manifestation of COVID-19 in the ICD-10-CM Official Guidelines for Coding and Reporting, it is essential to understand the syndrome for accurate and complete coding.

ARDS is a life-threatening lung injury that typically occurs in patients who are already in the hospital for trauma or infection. Providers may sparingly document ARDS, or they may document it along with acute respiratory failure. Although some patients can recover from ARDS completely, other patients experience long-lasting damage to their lungs.

The ARDS Definition Task Force in Berlin classifies stages of ARDS to identify the severity and is based on the degree of the hypoxemia:

• Mild: PaO2/FiO2 ≤ 300 mm Hg but > 200 mm Hg
• Moderate: PaO2/FiO2 ≤ 200 mm Hg but > 100 mm Hg
• Severe: PaO2/FiO2 ≤ 100 mm Hg

The common signs and symptoms associated with ARDS include:

• Confusion
• Cyanosis
• Extreme tiredness
• Low blood pressure
• Rapid, labored breathing
• Severe shortness of breath

ARDS can have a rapid onset, developing within one to two days of the original injury or infection. However, it may take up to four or five days to occur. Patients with ARDS are mainly treated in the intensive care unit (ICU) or the step-down unit.

ICD-10-CM classification of ARDS

Acute respiratory distress syndrome is reported with ICD-10-CM code J80 and has the following two inclusion terms listed in the Tabular List:

• Acute respiratory distress syndrome in adult or child
• Adult hyaline membrane disease

Respiratory failure is classified to ICD-10-CM category J96 (Respiratory failure, not elsewhere classified). Additional characters are available to identify if the respiratory failure is acute, chronic, or acute and chronic as well as with hypoxia or hypercapnia. When both respiratory failure and ARDS are documented in the same record, then only the code for ARDS is assigned based on coding directives under the respiratory failure category. According to current ICD-10-CM directives, when both respiratory failure and ARDS are documented in the same record, then only the code for ARDS is assigned due to the Excludes1 note under category J96. The Excludes1 note means that the condition is not coded here. In other words, it is assigned to the code listed in the coding directive.

This is just a summary of the many factors that should be considered when documenting and coding ARDS. For a complete discussion of the topic, we encourage Inside Angle readers to download a recent article we authored on the topic, published in JustCoding. You can find the article posted in the Inside Angle Knowledge Lab.

All HIM and coding professionals will likely agree that it is vital to report all COVID-19-related conditions, such as ARDS, to aid physicians and scientists in their research of the virus. The pandemic has also brought a multitude of new diagnosis and procedure codes with new coding guidelines. These new code sets call for a renewed emphasis on coding validation. Beyond payment accuracy, the right coding data offers tremendous long-term value, including researchable data and crucial insights into disease processes and progression, as well as outcomes at the aggregate level.

Audrey Howard, RHIA, is a senior outsource services consultant with 3M Health Information Systems.

Sue Belley, M.Ed., RHIA, CPHQ, is the manager of clinical content development and the manager of outsource services within the Consulting Services business of 3M Health Information Systems.

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