EmailCalculating the duration of continuous ventilatory support (CVS) for tracheostomy patients
Publication Date: June 2016
ICD 10 AM Edition: Ninth edition
Query Number: 3105
Could the Committee please provide clarification on the amended section in ICD-10-AM 9th edition ACS 1006 Ventilatory Support regarding the calculation of the duration of CVS for patients with a tracheostomy?
Specifically:
1. Does the directive to include the weaning in the duration of CVS up to a maximum of 24 hours following the cessation of CVS or the removal of the tracheostomy only apply to patients who have subsequent / multiple episodes of CVS during the one admission?
2. For a patient who has a singular episode of CVS via a tracheostomy, when does the duration of CVS end? Is it still correct to stop the count at the time of the last recording of pressure support?
Example:
Patient admitted for complex head and neck surgery for cancer, including a tracheostomy (surgery time 0800 - 1300). The patient was transferred to ICU post-operatively and was placed on SIMV for 44 hours, CPAP / PEEP for 22 hours and then oxygen via a high flow cannula for the next three days until transfer to the ward for continued care. Can the Committee please provide the procedure codes that would be assigned for the CVS hours and the total number of CVS hours in ICU for reporting purposes?
Specifically:
1. Does the directive to include the weaning in the duration of CVS up to a maximum of 24 hours following the cessation of CVS or the removal of the tracheostomy only apply to patients who have subsequent / multiple episodes of CVS during the one admission?
2. For a patient who has a singular episode of CVS via a tracheostomy, when does the duration of CVS end? Is it still correct to stop the count at the time of the last recording of pressure support?
Example:
Patient admitted for complex head and neck surgery for cancer, including a tracheostomy (surgery time 0800 - 1300). The patient was transferred to ICU post-operatively and was placed on SIMV for 44 hours, CPAP / PEEP for 22 hours and then oxygen via a high flow cannula for the next three days until transfer to the ward for continued care. Can the Committee please provide the procedure codes that would be assigned for the CVS hours and the total number of CVS hours in ICU for reporting purposes?
Response
The directive to include the weaning in the duration of CVS up to a maximum of 24 hours following the cessation of CVS or the removal of the tracheostomy applies to each episode of CVS.
VICC considers it is correct to stop the count at the time of the last recording of pressure support unless there is documentation of weaning of which you can add up to a maximum of 24 hours but please note that VICC has a query with ACCD seeking clarification of what constitutes weaning.
In terms of the example, if the oxygen via high flow cannula is provided via the tracheostomy it is considered continuation of the CVS and 13882-02 [569] Management of continuous ventilatory support, = 96 hours would be assigned.
If the oxygen via high flow cannula is not provided via the tracheostomy, the correct code for CVS would be 13882-01[569] Management of continuous ventilatory support, > 24 and < 96 hours. The administation of the high flow oxygen would be considered non invasive ventilation (NIV) and 92209-01[570] Management of noninvasive ventilatory support, > 24 and < 96 hours would be assigned as an additional code.
This is accordance with ACS 1006 Ventilatory support classification point 1 a. Which says:
'When both CVS and NIV are used for treatment (not weaning – see note d below), code each type separately. Use the appropriate duration extension on each code to indicate how many hours the patient received each type of ventilatory support'.
To calculate the hours reported in the Duration of Mechanical Ventilation Hours in ICU field in the VAED use the same principles as above and also refer to the VAED definition of the data element as well as the article titled Coding and reporting of CVS updated 2015 on the HDSS website.
VICC considers it is correct to stop the count at the time of the last recording of pressure support unless there is documentation of weaning of which you can add up to a maximum of 24 hours but please note that VICC has a query with ACCD seeking clarification of what constitutes weaning.
In terms of the example, if the oxygen via high flow cannula is provided via the tracheostomy it is considered continuation of the CVS and 13882-02 [569] Management of continuous ventilatory support, = 96 hours would be assigned.
If the oxygen via high flow cannula is not provided via the tracheostomy, the correct code for CVS would be 13882-01[569] Management of continuous ventilatory support, > 24 and < 96 hours. The administation of the high flow oxygen would be considered non invasive ventilation (NIV) and 92209-01[570] Management of noninvasive ventilatory support, > 24 and < 96 hours would be assigned as an additional code.
This is accordance with ACS 1006 Ventilatory support classification point 1 a. Which says:
'When both CVS and NIV are used for treatment (not weaning – see note d below), code each type separately. Use the appropriate duration extension on each code to indicate how many hours the patient received each type of ventilatory support'.
To calculate the hours reported in the Duration of Mechanical Ventilation Hours in ICU field in the VAED use the same principles as above and also refer to the VAED definition of the data element as well as the article titled Coding and reporting of CVS updated 2015 on the HDSS website.
