ARDS (noncardiogenic pulmonary edema)
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|Dx:||ARDS (noncardiogenic pulmonary edema)|
|APACHE Como Component:||none|
|APACHE Acute Component:||none|
|External ICD10 Documentation|
- Do not use this code if the patient has Transfusion-related acute lung injury (TRALI, form of ARDS)
- There have been a series of case definitions of ARDS over the years. For now we will use the latest, the "Berlin Definition", requiring ALL of these 4 criteria:
- Timing -- Within 1 week of a known clinical insult or new or worsening respiratory symptoms. Though note that this time interval is usually <72 hours.
- Imaging -- (new) bilateral opacities consistent with pulmonary edema -- not fully explained by effusions, lobar/lung collapse, or nodules. Prior definitions required 3 or 4 quadrants be involved, and though the Berlin definition only requires bilateral, one is more convinced if it is 3-4 quadrants.
- Pulmonary edema -- Respiratory failure NOT fully explained by cardiac failure or fluid overload. This vague statement further says "as judged by the treating physician using all available data" and that if there are no ARDS risk factors (i.e. causes) present, that objective assessment such as Echo is need to exclude CHF.
- Oxygenation -- a PaO2/FIO2 ratio <300 on PEEP or CPAP of at least 5 cmH2O.
- e.g: PaO2=55 on 50% O2 ---- P/F ratio = 55/0.5 = 110
- ARDS is actually a histopathologic delineation of a specific pattern of lung parenchymal injury. This pattern is called Diffuse Alveolar Damage (DAD) and can only be truly diagnosed with a tissue sample assessed under the microscope, which is rarely done in such patients.
- Unfortunately, there are a number of other kinds of lung damage that clinically can look like true ARDS, and the Berlin definition of ARDS is known to capture a substantial number of those things.
- The acute pulmonary fibrosis that can result from SARS-CoV-2 (COVID-19) is one of those other things. BUT, the bottom line for our coding is that if it meets the Berlin Definition of ARDS, code it as such.
Alternate ICD10s to consider coding instead or in addition
- Respiratory failure (insufficiency) NOS, acute
- Respiratory failure (insufficiency), chronic
- Respiratory failure (insufficiency) NOS, not specified as acute or chronic
- Hypercapnia (hypercarbia)
- Hypoxemia (hypoxia)
- ARDS (noncardiogenic pulmonary edema)
- Transfusion-related acute lung injury (TRALI, form of ARDS)
- Respiratory arrest
Candidate Combined ICD10 codes
- Also code the cause, if known.
Related CCI Codes
Data Integrity Checks (SMW)