About 10% of neonates require some form of respiratory assistance at birth. To assign ICD-10-PCS ventilation codes correctly, it is important for Coding Professionals to understand the difference between invasive and noninvasive ventilation. An understanding of respiratory assistance given solely for the purposes of newborn resuscitation vs ongoing respiratory assistance is also crucial.
Invasive Ventilation vs Noninvasive Ventilation: What’s the Difference?
Invasive ventilation replaces spontaneous breathing by delivering positive pressure to the lungs via an artificial airway, such as an endotracheal or tracheostomy tube (intubation).
In PCS, mechanical ventilation is replacing the respiratory effort, and should be reported to the Root Operation “Performance”, -- taking over the physiological function by extracorporeal means (Coding Clinic, First Quarter 2017 Pages: 29-30).
Noninvasive ventilation (NIV) refers to the administration of ventilatory support delivered via a noninvasive interface such as a face mask, nasal pillow, oral mouthpiece or oro-nasal mask, or without an endotracheal tube or tracheostomy (Coding Clinic, Fourth Quarter 2008 Pages 187-190). In PCS, when the ventilation is augmenting the respiratory effort, it is reported with the Root Operation “Assistance”,-- taking over a portion of a physiological function by extracorporeal means (Coding Clinic, First Quarter 2017 Pages: 29-30).
Types of respiratory assistance considered to be noninvasive include:
- Continuous positive airway pressure (CPAP)
- Bilevel positive airway pressure (BiPAP)
- Noninvasive pressure ventilation (NIPPV)
- Nonpositive pressure ventilation (NPPV)
- Mechanical ventilation not otherwise specified
Newborn Resuscitation and Noninvasive Ventilation
When it comes to noninvasive ventilation (NIV) in newborns, code assignment is based on whether the newborn received ongoing ventilatory assistance using NIV, or whether the NIV was briefly administered for the purpose of resuscitation. Ongoing ventilatory assistance using NIV is coded, however, in cases where NIV that is briefly administered to the newborn for the purpose of resuscitation, no PCS code is assigned. The resuscitation is considered to be inherent to the delivery and care of the newborn. (Coding Clinic First Quarter 2017 Pages: 29-30; Second Quarter 2008 Pages: 6-7).
Example 1: A newborn with a tight nuchal cord resulting in secondary apnea was briefly administered positive pressure ventilation (PPV) for resuscitation. No PCS code for the PPV is assigned, as the brief use of PPV done for resuscitation is considered inherent to the delivery.
Example 2: A newborn is placed on CPAP for several hours after delivery due to ongoing respiratory distress. Because the patient had ongoing respiratory assistance after delivery, PCS code 5A09357 Assistance with Respiratory Ventilation, Less than 24 Consecutive Hours, Continuous Positive Airway Pressure is assigned.
Example 3: A newborn with extreme prematurity is intubated, placed on a mechanical ventilation and admitted to the NICU. The newborn remains intubated and on the vent for greater than 96 consecutive hours. PCS codes 0BH17EZ Insertion of Endotracheal Airway into Trachea, Via Natural or Artificial Opening and 5A1955Z Respiratory Ventilation, Greater than 96 Consecutive hours are assigned.
Additional information regarding newborn resuscitation and ventilation can be found below:
- AHA Coding Clinic, First Quarter 2017 Pages: 29-30
- AHA Coding Clinic, Fourth Quarter 2008 Pages 187-190
- AHA Coding Clinic, Second Quarter 2008 Pages: 6-7
- Neonatal Resuscitation, Merk Manual: Professional Version https://www.merckmanuals.com/professional/pediatrics/perinatal-problems/neonatal-resuscitation
- Overview of Mechanical Ventilation, Merk Manual: Professional Version https://www.merckmanuals.com/professional/critical-care-medicine/respiratory-failure-and-mechanical-ventilation/overview-of-mechanical-ventilation
- 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care, Part 15: Neonatal Resuscitation https://www.ahajournals.org/doi/full/10.1161/circulationaha.110.971119
- Respiratory Care for the Ventilated Neonate, National Center for Biotechnology Information- National Library of Medicine https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6110042/
- An Active Simulator for Neonatal Intubation: Design, Development and Assessment, Science Direct https://www.sciencedirect.com/science/article/abs/pii/S1350453316302545
- Transient Tachypnea of the Newborn (TTN), Saint Luke’s Health System Kansas City https://www.saintlukeskc.org/health-library/transient-tachypnea-newborn-ttn
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