Types of RDS
Respiratory distress syndrome of a newborn can be documented as Type I RDS (769) or Type II RDS (770.6). If the type of RDS is not specified, assign code 769. Other terms synonymous with Type I RDS include the following:

• cardiorespiratory distress syndrome of newborn;

• hyaline membrane disease;

• idiopathic respiratory distress syndrome of newborn;

• infantile or infant respiratory distress syndrome;

• neonatal respiratory distress syndrome; and

• pulmonary hypoperfusion syndrome.

Type II RDS is also called transient tachypnea of the newborn (TTN), classified by fast breathing that gradually gets better. It is caused by slow reabsorption of fetal lung fluid. TTN is more common in babies delivered by cesarean section because they did not have fluid squeezed out with delivery. TTN is mild and usually resolves within six to 24 hours of birth (AHA Coding Clinic for ICD-9-CM, 1989, first quarter, page 10; 1986, N/D, page 6). However, it may not resolve for 24 to 48 hours after birth or even longer. If the physician documents TTN but the condition lasted longer than two days, still assign the code for TTN (770.6) based on the physician’s documentation and not the time frame of the condition (AHA Coding Clinic for ICD-9-CM, 1993, third quarter, page 7).

Signs and Symptoms of RDS
Common signs and symptoms of Type I RDS include the following:

• tachypnea/rapid breathing;

• intercostals retractions (pulling in of the ribs and sternum with each breath);

• shortness of breath;

• nasal flaring;

• grunting;

• cessation of breathing;

• cyanosis;

• acidosis;

• respiratory distress; and

• atelectasis.

Diagnosis of RDS
Diagnostic tests for Type I RDS include chest x-rays, pulmonary function studies, and blood gas analysis, which shows low oxygen and acidosis. Blood cultures may also be done to rule out infection and sepsis as a cause of the respiratory distress.

Treatment of RDS
Treatment for Type I RDS includes high oxygen and humidity concentrations. Mild cases will receive supplemental oxygen while patients with severe cases may be placed on continuous positive airway pressure (CPAP) or a mechanical ventilator.

If it is determined that premature birth is unavoidable, the mother may take corticosteroids 48 to 72 hours before delivery to stimulate the baby’s lungs to produce surfactant. After delivery, the baby may take a surfactant directly into the lungs through an endotracheal tube. A baby must be intubated to receive surfactant, and it is most effective if started within six hours of birth.

These drugs can sometimes prevent RDS from developing or decrease its severity. Some surfactants include beractant (Survanta), poractant alfa (Curosurf), calfactant (Infasurf), and Exosurf Neonatal (a synthetic product that combines colfosceril palmitate, cetyl alcohol, and tyloxapol). It has been shown that surfactants can reduce mortality from RDS, which typically worsens over the first two to three days after birth and then improves with treatment.

Complications
Complications of Type I RDS include the following:

• cardiac arrest (779.89);

• pneumothorax (770.2);

• pneumomediastinum (770.2);

• pneumopericardium (770.2);

• pulmonary interstitial emphysema (770.2);

• bronchopulmonary dysplasia (770.7);

• intraventricular bleed (772.1x);

• hemorrhage into the lung (770.3); and

• delayed mental development (315.9).

Signs and Symptoms of TTN
Common signs and symptoms of TTN include the following:

• rapid breathing;

• grunting; and

• nostril flaring.

Treatment of TTN
Treatment of TTN includes oxygen and CPAP. It is possible for TTN to last from a few hours to a few days. The baby’s need for oxygen will gradually decrease. Then the respiratory rate will slowly decrease to normal.

If a newborn presents with many of the signs and symptoms listed under RDS and is being treated with oxygen, ventilator, or surfactants—but the physician did not document RDS (or any other synonymous term)—then the physician should be asked to clarify the diagnosis. Because TTN has some of the same signs and symptoms as RDS, it will be important to obtain physician documentation of the appropriate diagnosis.

Coding and sequencing for RDS are dependent on the physician documentation in the medical record and application of the Official Coding Guidelines for inpatient care. Also, use specific AHA Coding Clinic for ICD-9-CM and American Medical Association CPT Assistant references to ensure complete and accurate coding.