ICD-10: Respiratory System Diseases

Published in Coding Edge – September 2008
By Deborah Grider, CPC, CPC-H, CPC-I, CPC-P, CEMC, CPMA, COBGC, CPCD, CCS-P
On our journey using the ICD-10-CM roadmap, we have reviewed ICD-10-CM documentation issues, implementation issues, and crosswalking and mapping. Now, the roadmap leads us to reviewing the draft guidelines and coding issues in ICD-10-CM, focusing on “Understanding the ICD-10-CM Draft Guidelines for Diseases of the Respiratory System,” found in chapter 10.
Chapter 10 of ICD-10-CM includes the following blocks:
J00–J06  Acute upper respiratory infections
J10–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–J99   Other diseases of the respiratory system
ICD-10-CM draft guidelines address chronic obstructive pulmonary disease (COPD) and it should be coded as J44.Conditions included in this category are:

• asthma with chronic obstructive pulmonary disease (COPD)
• chronic asthmatic (obstructive) bronchitis
• chronic bronchitis with airways obstruction
• chronic bronchitis with emphysema
• chronic emphysematous bronchitis
• chronic obstructive asthma
• chronic obstructive bronchitis
• chronic obstructive tracheobronchitis

Review the Figure A excerpt from ICD-10-CM’s tabular list.
Figure A: Excerpt ICD-10-CM Tabular List J44.0
J44.0 Chronic obstructive pulmonary disease with acute lower respiratory infection.
Use additional code to identify the infection
J44.1 Chronic obstructive pulmonary disease with (acute) exacerbation
                Decompensated COPD
                Decompensated COPD with (acute) exacerbation
 Excludes2: chronic obstructive pulmonary disease [COPD] with acute bronchitis (J44.0)
  J44.9   Chronic obstructive pulmonary disease, unspecified
                 Chronic obstructive airway disease NOS
                 Chronic obstructive lung disease NOS
For a patient with a combination of chronic obstructive lung problems, a single code from category J44 is usually appropriate. Any combination not included in J44 is reported separately.
For example, if the medical record’s documentation indicates the patient has an uncomplicated case, an acute exacerbation, or a co-existing lower respiratory infection, then the code for the lower respiratory infection takes precedence over the acute exacerbation. If the infection is pneumonia or the flu, a secondary code for the type of pneumonia or flu is required.
Example: A patient with COPD was admitted by her internist with a diagnosis of COPD with respiratory synctytial virus pneumonia.

Nosocomial Respiratory Infections

If a patient contracts a respiratory infection while in the hospital, a Y95 code is assigned with the type of infection. The infection is reported as the principal or first listed diagnosis.
Example: A patient treated in the hospital developed a staph infection and was treated with antibiotics.
The encounter is reported as:
Principal/first listed diagnosis: B95.8  Unspecified staphylococcus as the cause of diseases classified elsewhere
Secondary diagnosis: Y95  Nosocomial condition
Note: The unspecified staphylococcus is reported with B95.8, because the type of staph infection is not documented.

Acute Tonsillitis

Acute tonsillitis in ICD-10-CM has been expanded at the fourth and fifth characters. The fourth character identifies the organism and the fifth character level indicates whether the condition is acute or recurrent. The fifth character “1” identifies recurrent tonsillitis.
Excerpt from ICD-10-CM (Acute tonsillitis)
 J03 Acute tonsillitis
           J03.0    Streptococcal tonsillitis
                            J03.00  Acute streptococcal tonsillitis, unspecified
                            J03.01  Acute recurrent streptococcal tonsillitis
             J03.8    Acute tonsillitis due to other specified organisms
                              J03.80  Acute tonsillitis due to other specified organisms
                              J03.81  Acute recurrent tonsillitis due to other specified organisms
             J03.9    Acute tonsillitis, unspecified
                             Follicular tonsillitis (acute)
                             Gangrenous tonsillitis (acute)
                              Infective tonsillitis (acute)
                              Tonsillitis (acute) NOS
                              Ulcerative tonsillitis (acute)
                              J03.90  Acute tonsillitis, unspecified
                               J03.91  Acute recurrent tonsillitis, unspecified
In ICD-9-CM acute tonsillitis is coded in category 463 Acute tonsillitis. ICD-9-CM doesn’t specify the organism type and if the condition is recurrent.
Example: A patient was seen by his family physician and diagnosed with acute tonsillitis. The patient had a previous acute bout of tonsillitis six month ago and this is the second occurrence in six months.

 Currently, in ICD-9-CM there is not a code to report recurrent tonsillitis.

 Acute Pharyngitis

In ICD-10-CM, acute pharyngitis has expanded to delineate the causative organism. Review the comparison between ICD-9-CM and ICD-10-CM.

Asthma

ICD-9-CM category code 493 Asthma has a fourth digit specifying the type of asthma (extrinsic, intrinsic, chronic obstructive, and unspecified) and a fifth digits delineating the presence or the absence of status asthmaticus or an acute exacerbation.
ICD-10-CM category J45 Asthma includes a fifth digit specifying whether the asthma was uncomplicated, with acute exacerbation, or with status asthmaticus. Category J45 identifies mild intermittent, moderate persistent, and severe persistent asthma.
Compare category 493  of ICD-9-CMwith Category J45 of ICD-10-CM:

In addition to coding the respiratory system condition in ICD-10-CM, there is an instructional note in many of the subclassifications in chapter 10, as shown here:
Diseases of the respiratory system (J00–J99)
Use additional code, where applicable, to identify:

• exposure to environmental tobacco smoke (Z58.83)
• exposure to tobacco smoke in the perinatal period (P96.6)
• history of tobacco use (Z86.43)
• occupational exposure to environmental tobacco smoke (Z57.31)
• tobacco dependence (F17.x)
• tobacco use (Z72.0)

Codes for When Complications Arise
Complication codes were added in ICD-10-CM’s category J95 Intraoperative and postprocedural complications and disorders of respiratory system, not elsewhere classified to identify intraoperative and postprocedural complications and respiratory system disorders. This category includes a variety of codes with a fifth and sixth digit subclassification. A few examples of category J95 codes are:
 J95.61   Intraoperative hemorrhage and hematoma of a respiratory system organ or structure complicating a
                  respiratory system procedure
J95.71    Accidental puncture and laceration of a respiratory system organ or structure during a respiratory system
                  procedure
J95.831  Postprocedural hemorrhage and hematoma of a respiratory system organ or structure following other
                   procedure

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