Diseases of the Respiratory System: (ICD-9-CM Chapter 8, Codes 460-519, and ICD-10-CM Chapter 10, Codes J00-J99)



Diseases of the Respiratory System


(ICD-9-CM Chapter 8, Codes 460-519, and ICD-10-CM Chapter 10, Codes J00-J99)



Learning Objectives



1. Apply and assign the correct ICD-9-CM and ICD-10-CM codes in accordance with Official Guidelines for Coding and Reporting.


2. Identify major differences between ICD-9-CM and ICD-10-CM related to the respiratory system


3. Identify pertinent anatomy and physiology of the respiratory system


4. Identify diseases of the respiratory system


5. Assign the correct V/Z codes and procedure codes related to the respiratory system


6. Identify common treatments, medications, laboratory values, and diagnostic tests


7. Explain the importance of documentation in relation to MS-DRGs for reimbursement



Abbreviations/Acronyms










































ICD-9-CM Official Guidelines for Coding and Reporting


Please refer to the companion Evolve website for the most current guidelines.




8. Chapter 8: Diseases of Respiratory System (460-519)


    See I.C.17.f. for ventilator-associated pneumonia.



a. Chronic Obstructive Pulmonary Disease [COPD] and Asthma



1) Conditions that comprise COPD and Asthma


    The conditions that comprise COPD are obstructive chronic bronchitis, subcategory 491.2, and emphysema, category 492. All asthma codes are under category 493, Asthma. Code 496, Chronic airway obstruction, not elsewhere classified, is a nonspecific code that should only be used when the documentation in a medical record does not specify the type of COPD being treated.


2) Acute exacerbation of chronic obstructive bronchitis and asthma


    The codes for chronic obstructive bronchitis and asthma distinguish between uncomplicated cases and those in acute exacerbation. An acute exacerbation is a worsening or a decompensation of a chronic condition. An acute exacerbation is not equivalent to an infection superimposed on a chronic condition, though an exacerbation may be triggered by an infection.


3) Overlapping nature of the conditions that comprise COPD and asthma


    Due to the overlapping nature of the conditions that make up COPD and asthma, there are many variations in the way these conditions are documented. Code selection must be based on the terms as documented. When selecting the correct code for the documented type of COPD and asthma, it is essential to first review the index, and then verify the code in the tabular list. There are many instructional notes under the different COPD subcategories and codes. It is important that all such notes be reviewed to assure correct code assignment.


4) Acute exacerbation of asthma and status asthmaticus


    An acute exacerbation of asthma is an increased severity of the asthma symptoms, such as wheezing and shortness of breath. Status asthmaticus refers to a patient’s failure to respond to therapy administered during an asthmatic episode and is a life threatening complication that requires emergency care. If status asthmaticus is documented by the provider with any type of COPD or with acute bronchitis, the status asthmaticus should be sequenced first. It supersedes any type of COPD including that with acute exacerbation or acute bronchitis. It is inappropriate to assign an asthma code with 5th digit 2, with acute exacerbation, together with an asthma code with 5th digit 1, with status asthmatics. Only the 5th digit 1 should be assigned. (See Figure 16-1.)


image
Figure 16-1 Fifth digits for asthma.

b. Chronic Obstructive Pulmonary Disease [COPD] and Bronchitis



c. Acute Respiratory Failure



1) Acute respiratory failure as principal diagnosis


    Code 518.81, Acute respiratory failure, may be assigned as a principal diagnosis when it is the condition established after study to be chiefly responsible for occasioning the admission to the hospital, and the selection is supported by the Alphabetic Index and Tabular List. However, chapter-specific coding guidelines (such as obstetrics, poisoning, HIV, newborn) that provide sequencing direction take precedence.



Example


The patient presented to the ER in acute respiratory failure and was intubated and admitted to ICU. Following admission, the patient was started on antibiotics for pneumonia. The patient was on mechanical ventilation for 24 hours. 518.81, 486, 96.71, 96.04 (J96.00, J18.9, 5A1945Z, 0BH17EZ).


(Per guidelines, if respiratory failure and another acute condition are equally responsible for occasioning the admission, the guidelines regarding two or more diagnoses that equally meet the definition for principal diagnoses may be applied.)


2) Acute respiratory failure as secondary diagnosis


    Respiratory failure may be listed as a secondary diagnosis if it occurs after admission, or if it is present on admission, but does not meet the definition of principal diagnosis.



Example


The patient was admitted from the clinic for IV antibiotics for pneumonia. A couple of hours after admission, the patient’s condition deteriorated and acute respiratory failure developed, 486, 518.81 (J18.9, J96.00).


3) Sequencing of acute respiratory failure and another acute condition


    When a patient is admitted with respiratory failure and another acute condition, (e.g., myocardial infarction, cerebrovascular accident, aspiration pneumonia), the principal diagnosis will not be the same in every situation. This applies whether the other acute condition is a respiratory or nonrespiratory condition. Selection of the principal diagnosis will be dependent on the circumstances of admission. If both the respiratory failure and the other acute condition are equally responsible for occasioning the admission to the hospital, and there are no chapter-specific sequencing rules, the guideline regarding two or more diagnoses that equally meet the definition for principal diagnosis (Section II, C.) may be applied in these situations.


    If the documentation is not clear as to whether acute respiratory failure and another condition are equally responsible for occasioning the admission, query the provider for clarification.



Example


Patient was admitted to the hospital in acute respiratory failure due to congestive heart failure. The patient was intubated and placed on mechanical ventilation for 2 days. The patient responded well to IV diuretics, 518.81, 428.0, 96.71, 96.04 (J96.00, I50.9, 5A1945Z, 0BH17EZ).


d. Influenza due to certain identified viruses


    Code only confirmed cases of avian influenza (codes 488.01-488.02, 488.09, Influenza due to identified avian influenza virus), 2009 H1N1 influenza virus (codes 488.11-488.12, 488.19), or novel influenza A (codes 488.81-488.82, 488.89, Influenza due to identified novel influenza A virus). This is an exception to the hospital inpatient guideline Section II, H. (Uncertain Diagnosis).


    In this context, “confirmation” does not require documentation of positive laboratory testing specific for avian, 2009 H1N1 or novel influenza A virus. However, coding should be based on the provider’s diagnostic statement that the patient has avian influenza, 2009 H1N1 influenza, or novel influenza A.


    If the provider records “suspected” or “possible” or “probable” avian, 2009 H1N1, or novel influenza A, the appropriate influenza code from category 487, Influenza should be assigned. A code from category 488, Influenza due to certain identified influenza viruses, should not be assigned.



Example


Patient was admitted with a confirmed case of avian influenza, 488.02 (J09.X2).



Example


Patient was admitted with possible H1N1 influenza, 487.1 (J11.1).


Apply the General Coding Guidelines as found in Chapter 5 and the Procedural Guidelines as found in Chapter 6.



ICD-10-CM Official Guidelines for Coding and Reporting


Please refer to the companion Evolve website for the most current guidelines.




10. Chapter 10: Diseases of Respiratory System (J00-J99)



a. Chronic Obstructive Pulmonary Disease [COPD] and Asthma



b. Acute Respiratory Failure



1) Acute respiratory failure as principal diagnosis


    A code from subcategory J96.0, Acute respiratory failure, or subcategory J96.2, Acute and chronic respiratory failure, may be assigned as a principal diagnosis when it is the condition established after study to be chiefly responsible for occasioning the admission to the hospital, and the selection is supported by the Alphabetic Index and Tabular List. However, chapter-specific coding guidelines (such as obstetrics, poisoning, HIV, newborn) that provide sequencing direction take precedence.


2) Acute respiratory failure as secondary diagnosis


    Respiratory failure may be listed as a secondary diagnosis if it occurs after admission, or if it is present on admission, but does not meet the definition of principal diagnosis.


3) Sequencing of acute respiratory failure and another acute condition


    When a patient is admitted with respiratory failure and another acute condition, (e.g., myocardial infarction, cerebrovascular accident, aspiration pneumonia), the principal diagnosis will not be the same in every situation. This applies whether the other acute condition is a respiratory or nonrespiratory condition. Selection of the principal diagnosis will be dependent on the circumstances of admission. If both the respiratory failure and the other acute condition are equally responsible for occasioning the admission to the hospital, and there are no chapter-specific sequencing rules, the guideline regarding two or more diagnoses that equally meet the definition for principal diagnosis (Section II, C.) may be applied in these situations.


    If the documentation is not clear as to whether acute respiratory failure and another condition are equally responsible for occasioning the admission, query the provider for clarification.


c. Influenza due to certain identified influenza viruses


    Code only confirmed cases of influenza due to certain identified influenza viruses (category J09). This is an exception to the hospital inpatient guideline Section II, H. (Uncertain Diagnosis).


    In this context, “confirmation” does not require documenttation of positive laboratory testing specific for avian or other novel influenza A. However, coding should be based on the the provider’s diagnostic statement that the patient has avian influenza, or other novel influenza A.


    If the provider records “suspected” or “possible” or “probable” avian influenza, the appropriate influenza code from category J11, Influenza due to unidentified influenza virus, should be assigned. A code from category J09, Influenza due to certain identified influenza viruses, should not be assigned.


d. Ventilator associated Pneumonia



1) Documentation of Ventilator associated Pneumonia


    As with all procedural or postprocedural complications, code assignment is based on the provider’s documentation of the relationship between the condition and the procedure.Code J95.851, Ventilator associated pneumonia, should be assigned only when the provider has documented ventilator associated pneumonia (VAP). An additional code to identify the organism (e.g., Pseudomonas aeruginosa, code B96.5) should also be assigned. Do not assign an additional code from categories J12-J18 to identify the type of pneumonia.


    Code J95.851 should not be assigned for cases where the patient has pneumonia and is on a mechanical ventilator but the provider has not specifically stated that the pneumonia is ventilator-associated pneumonia. If the documentation is unclear as to whether the patient has a pneumonia that is a complication attributable to the mechanical ventilator, query the provider.


2) Ventilator associated Pneumonia Develops after Admission


    A patient may be admitted with one type of pneumonia (e.g., code J13, Pneumonia due to Streptococcus pneumonia) and subsequently develop VAP. In this instance, the principal diagnosis would be the appropriate code from categories J12-J18 for the pneumonia diagnosed at the time of admission. Code J95.851, Ventilator associated pneumonia, would be assigned as an additional diagnosis when the provider has also documented the presence of ventilator associated pneumonia.


Apply the General Coding Guidelines as found in Chapter 5 and the Procedural Guidelines as found in Chapter 7.




Major Differences between ICD-9-CM and ICD-10-CM Guidelines




image ICD-10-CM uses codes that identify acute recurrent sinusitis to the individual sinuses.


image In ICD-9-CM, asthma is coded by specific type (e.g., extrinsic, intrinsic, chronic obstructive, or unspecified) and by whether the condition is exacerbated or status asthmaticus is present. ICD-10-CM divides asthma into the following subcategories:



image Under code category J44, Other chronic obstructive pulmonary disease, there is an instructional notation to code also the type of asthma if applicable (J45.-). In ICD-9-CM, asthma associated with COPD is only one combination code. In ICD-10-CM, both conditions are assigned codes if the specific type of asthma is docomented.


image In ICD-10-CM, an instructional note at the beginning of the chapter states that if a respiratory condition occurs in more than one site, and it is not specifically indexed, it should be classified to the lower anatomic site, such as tracheobronchitis would be classified to bronchitis.


image Procedural complications affecting the respiratory system are included in Chapter 10, Diseases of the Respiratory System, of ICD-10-CM. Some of the complications include:




Anatomy and Physiology


The primary function of the respiratory system (Figure 16-2) is to supply the body with oxygen (O2). Respiration occurs through the nose and mouth, bringing oxygen through the larynx and trachea and into the lungs, where oxygen is delivered and carbon dioxide is exhaled. Dome-shaped muscles at the bottom of the lungs, or the diaphragm, assist in the process of breathing and in the exchange of oxygen/carbon dioxide. The lungs are the major organ of the respiratory system. The right lung is made up of three lobes; the left lung is smaller and contains two lobes. The bronchi are the two air tubes that branch off the trachea and deliver air to both lungs. The trachea, or windpipe, is responsible for filtering the air that we breathe.


image
Figure 16-2 Anatomy of the respiratory system.


Disease Conditions


Diseases of the Respiratory System (460-519), Chapter 8 in the ICD-9-CM code book, is divided into the following categories:


























CATEGORY SECTION TITLES
460-466 Acute Respiratory Infections
470-478 Other Diseases of the Upper Respiratory Tract
480-488 Pneumonia and Influenza
490-496 Chronic Obstructive Pulmonary Disease and Allied Conditions
500-508 Pneumoconioses and Other Lung Disease Due to External Agents
510-519 Other Disease of Respiratory System

Diseases of the Respiratory System, Chapter 10 in the ICD-10-CM code book, are divided into the following categories:









































CATEGORY SECTION titles
J00-J06 Acute Upper Respiratory Infections
J09-J18 Influenza and Pneumonia
J20-J22 Other Acute Lower Respiratory Infections
J30-J39 Other Diseases of Upper Respiratory Tract
J40-J47 Chronic Lower Respiratory Diseases
J60-J70 Lung Diseases Due to External Agents
J80-J84 Other Respiratory Diseases Principally Affecting the Interstitium
J85-J86 Suppurative and Necrotic Conditions of the Lower Respiratory Tract
J90-J94 Other Diseases of the Pleura
J95 Intraoperative and Postprocedural Complications and Disorders of Respiratory System, Not Elsewhere Classified
J96-J99 Other Diseases of the Respiratory System

At the very beginning of Chapter 8 is an instruction to use an additional code to identify the infectious organism (Figure 16-3). In the Respiratory chapter, some codes are provided that do include the organisms. When the organism is included, it is not necessary to assign an additional code.


image
Figure 16-3 Instruction to use additional code to identify infectious organism.


Example


Pneumonia due to respiratory syncytial virus, 480.1 (J12.1).


This is a combination code that includes the disease process, pneumonia, and the causative organism, respiratory syncytial virus (RSV). No additional code is necessary to identify the organism.



Example


Acute laryngitis due to Haemophilus influenzae, 464.00, 041.5 (J04.0, B96.3).


In this case, laryngitis is due to Haemophilus influenzae bacteria (H flu). The code for acute laryngitis, 464.0 (J04.0) makes no mention of the causative bacteria; therefore, code 041.5 (B96.3) is assigned as an additional code to identify the bacteria.



Acute Respiratory Infections and Other Diseases of the Upper Respiratory Tract


Infection is invasion of the body by organisms that have the potential to cause disease. This section deals with infections of the upper respiratory tract and the bronchus. It must be noted that diseases in this section are identified as acute infections. It is possible that an acute infection may be superimposed upon a chronic infection or inflammation. Following general guidelines, “If the same condition is described as both acute (subacute) and chronic, and separate subentries exist in the Alphabetic Index at the same indentation level, code both and sequence the acute (subacute) code first” (Figure 16-4).


image
Figure 16-4 Alphabetic Index for acute and chronic bronchitis.


Example


Acute and chronic bronchitis, 466.0, 491.9 (J20.9, J42).


Acute sinusitis occurs when the linings of one or more sinuses become infected, usually because of viruses or bacteria. Sinuses may swell, causing an obstruction and interfering with the normal drainage of mucus. This may occur as the result of a cold. Sinusitis can cause considerable discomfort and may lead to more serious infection.



Example


Acute maxillary sinusitis, 461.0 (J01.00).



Example


Chronic maxillary sinusitis, 473.0 (J32.0).


Acute bronchitis is a lower respiratory tract or bronchial tree infection that may be characterized by cough, sputum production, and wheezing. Most cases of acute bronchitis are caused by viruses such as RSV, influenza, and parainfluenza. Bacterial infection with Mycoplasma pneumoniae, Chlamydia pneumoniae, and Bordetella pertussis (whooping cough), particularly in young adults, can lead to acute bronchitis. Bronchitis may progress to pneumonia or may aggravate respiratory symptoms in those who have chronic respiratory conditions.



Example


Subacute bronchitis with bronchospasm, 466.0 (J20.9).





Pneumonia and Influenza


Pneumonia is an infection of the lungs that can be caused by a variety of organisms, including viruses, bacteria, and parasites. Pneumonia frequently follows an upper respiratory infection, and symptoms depend on age and cause of the pneumonia. More than 50 different types of pneumonia have been identified. High-risk individuals include the elderly, the very young, and those with underlying health problems such as chronic obstructive pulmonary disease (COPD), diabetes mellitus, congestive heart failure, asthma, and sickle cell anemia. Those with impaired immune systems as the result of human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS), cancer therapy, steroid therapy, or anti-rejection medications are also at risk for developing pneumonia.


Some common symptoms of pneumonia include the following:



Community-acquired pneumonia (CAP) is a broad term that is used to refer to pneumonias that are contracted outside of the hospital or nursing home setting. The most common cause of CAP is Streptococcus pneumoniae. Nosocomial pneumonia refers to a pneumonia that is acquired while the patient is hospitalized. Hospital patients are most susceptible to Gram-negative bacteria and staphylococcal pneumonia. Nursing home-acquired pneumonia refers to a pneumonia that is acquired in a nursing home or extended care facility. More than one organism may be responsible for pneumonia. In this case, pneumonia codes would be assigned to identify both types of pneumonia. If this was the reason for the hospital stay, either could be sequenced as the principal diagnosis. See Table 16-1 for other pathogens responsible for pneumonia. Complications of pneumonia include the formation of abscesses, respiratory failure, bacteremia, pleural effusion, empyema, and pneumothorax.



TABLE 16-1


COMMON CAUSES OF PNEUMONIA2















































Causative Agents Percentage of All Diagnosed Cases
Bacteria 50
 Streptococcus pneumoniae 10
 Haemophilus influenzae 5
 Staphylococcus aureus 5
 Mycobacterium tuberculosis 10
Viruses  
 Influenza virus –
Fungi*  
 Aspergillus fumigatus –
 Candida albicans –
 Pneumocystis jiroveci –
Bacterium-like organisms  
 Mycoplasma pneumoniae 10

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Jun 14, 2017 | Posted by in GENERAL SURGERY | Comments Off on Diseases of the Respiratory System: (ICD-9-CM Chapter 8, Codes 460-519, and ICD-10-CM Chapter 10, Codes J00-J99)

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