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 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.
|Principal/first listed diagnosis: 480.1 Viral Pneumonia; pneumonia due to respiratory syncytial virusSecondary diagnosis: 496 Chronic airway obstruction, not elsewhere classified||Principal/first listed diagnosis: J44.0 Chronic obstructive pulmonary disease with acute lower respiratory infectionSecondary diagnosis: J12.1 Respiratory syncytial 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 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.
|463 Acute tonsillitis||J03.91 Acute recurrent tonsillitis, unspecified|
Currently, in ICD-9-CM there is not a code to report recurrent tonsillitis.
In ICD-10-CM, acute pharyngitis has expanded to delineate the causative organism. Review the comparison between ICD-9-CM and ICD-10-CM.
|462 Acute pharyngitis||J02 Acute pharyngitis J02.0 Streptococcal pharyngitis J02.8 Acute pharyngitis due to other specified
J02.9 Acute pharyngitis, unspecified
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:
|493 Asthma 493.0 Extrinsic asthma 493.00 Extrinsic asthma, unspecified 493.01 Extrinsic asthma, with status
asthmaticus 493.02 Extrinsic asthma, with (acute)
exacerbation 493.1 Intrinsic asthma
493.10 Intrinsic asthma, unspecified
493.11 Intrinsic asthma, with status
493.12 Intrinsic asthma, with (acute)
493.20 Chronic obstructive asthma,
493.21 Chronic obstructive asthma, with
493.22 Chronic obstructive asthma, with
493.8 Other forms of asthma
493.81 Exercise induced bronchospasm
493.82 Cough variant asthma
493.9 Asthma, unspecified 493.90
493.91 Asthma, unspecified, with status
493.92 Asthma, unspecified, with (acute)
|J45 Asthma J45.2 Mild intermittent asthma J45.20 Mild intermittent asthma, uncomplicated Mild intermittent asthma NOS J45.21 Mild intermittent asthma with (acute) exacerbation J45.22 Mild intermittent asthma with status asthmaticus
J45.3 Mild persistent asthma
J45.30 Mild persistent asthma, uncomplicated
Mild persistent asthma NOS
J45.31 Mild persistent asthma with (acute) exacerbation
J45.32 Mild persistent asthma with status asthmaticus
J45.4 Moderate persistent
J45.40 Moderate persistent, uncomplicated
Moderate persistent asthma NOS
J45.41 Moderate persistent with (acute) exacerbation
J45.42 Moderate persistent with status asthmaticus
J45.5 Severe persistent
J45.50 Severe persistent, uncomplicated
Severe persistent asthma NOS
J45.51 Severe persistent with (acute) exacerbation
J45.52 Severe persistent with status asthmaticus
J45.9 Other and unspecified asthma
J45.90 Unspecified asthma
NOS Late onset asthma
J45.901 Unspecified asthma with (acute)
J45.902 Unspecified asthma with status
J45.909 Unspecified asthma, uncomplicated
J45.99 Other asthma
J45.990 Exercise induced bronchospasm
J45.991 Cough variant asthma
J45.998 Other asthma
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
J95.831 Postprocedural hemorrhage and hematoma of a respiratory system organ or structure following other