ICD 10 Coding Alert

Find out why the order of your symptom codes matters as much as your primary Dx.

In your practice, you undoubtedly encounter patients grappling with the discomfort of difficult breathing. Often, your practitioner will have a list of symptoms or patient concerns prior to reaching a diagnosis. Understanding which symptoms should be coded, and in which order, can make or break your claim.

Consider the importance of adding symptomatic ICD-10-CM codes to your claim in the correct order when you’re coding patients who present to your practice with breathing difficulties, and you’ll not only quickly narrow down your code choices, but you’ll have more successful claims.

Review the following scenarios to enhance your ICD-10-CM symptom coding skills.

Work Out This Cold Complicated by Asthma Case

Scenario: A patient who regularly manages their asthma with medication presented with symptoms of congestion, severe cough, and breathing problems. The healthcare provider identified these symptoms as those of a typical cold and recommended a temporary regimen of a steroid inhaler to alleviate the asthma-induced cough worsened by the cold.

Solution: First, you’ll code for the cold, then the asthma. Let’s take a closer look at the how and why together.

ICD-10-CM Official Guidelines, Section I.B.8 says, “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,” sequence the acute code first and the chronic code second. However, this rule doesn’t apply in this patient’s case. Notice that when you look up “Asthma” in the Alphabetic Index, it lists neither “acute” nor “subacute” as a subentry at the same indentation level as “chronic obstructive.”

In this patient’s scenario, the cold is the primary reason for the encounter. The patient is presenting with cold symptoms and seeking treatment related to those symptoms. Chronic asthma impacts treatment like any comorbid condition, as supported by the prescription of the inhaler, which would not be typical for someone with a cold. So, in this case, you’ll report J00 (Acute nasopharyngitis [common cold]), then list J45.901(Unspecified asthma with (acute) exacerbation) as the second code.

Code This Acute Bronchiolitis Case Due to RSV

Scenario: The parents of an 8-month-old baby rushed to the emergency department (ED) due to the child’s breathing difficulties and wheezing. After taking the patient’s history and conducting a physical examination, the practitioner noted symptoms of fever, rapid breathing (tachypnea), and fast heart rate (tachycardia), along with wheezing sounds detected during auscultation. Given the patient’s age, symptoms, and the prevalence of acute bronchiolitis cases in the locality, the practitioner made an initial diagnosis of acute bronchiolitis. Subsequent lab tests confirmed the diagnosis as acute bronchiolitis caused by respiratory syncytial virus (RSV).

Solution: As the lab reports confirmed the doctor’s diagnosis, you’ll assign J21.0 (Acute bronchiolitis due to respiratory syncytial virus). The code features an additional synonym of “Acute bronchiolitis due to RSV.” The provider may abbreviate respiratory syncytial virus as RSV in their documentation. Always be sure to query them if you’re unsure of any abbreviations.

The parent code J21.- (Acute bronchiolitis) features an Includes note that covers acute bronchiolitis with bronchospasm. Additionally, the Excludes2 note for J21.- allows you to code J84.115 (Respiratory bronchiolitis interstitial lung disease) along with J21.0 if the patient is also suffering from that condition along with acute bronchiolitis.

Check Excludes Notes in Severe Asthma Situation

Scenario: A 27-year-old individual sought immediate medical attention at an urgent care center due to a severe asthma flare-up. The individual was struggling to breathe and exhibited wheezing. Despite attempting to use their usual inhaler at home, it proved ineffective. To alleviate the symptoms, the doctor provided an asthma nebulizer treatment. Once the patient’s condition was stable, they were diagnosed with status asthmaticus.

Solution: To report status asthmaticus, you’ll assign J45.902 (Unspecified asthma with status asthmaticus) to your claim. Status asthmaticus describes a patient who isn’t responding to treatment after an acute exacerbation of asthma.

ICD-10-CM parent code J45.- (Asthma) features an Includes note that indicates several other conditions covered in the code family. Some of these conditions include allergic (predominantly) asthma, hay fever with asthma, and allergic bronchitis NOS.

Excludes1 note: Parent code J45.- also features an Excludes1 note to indicate you won’t report J69.8 (Pneumonitis due to inhalation of other solids and liquids), J82.- (Pulmonary eosinophilia, not elsewhere classified), J60 (Coalworker’s pneumoconiosis), R06.2 (Wheezing), or J67.8 (Hypersensitivity pneumonitis due to other organic dusts) with J45.- codes.

Determine the Solution to This Dry Cough Case

Scenario: A patient presented with a persistent dry cough and difficulty breathing. The practitioner performed a physical examination, documented the patient’s history, and ordered a CT scan of the patient’s chest. The physician diagnosed the patient with idiopathic fibrosing alveolitis.

Solution: In this case, you won’t assign codes based on the symptoms the patient presented with. Instead, you’ll only assign J84.112 (Idiopathic pulmonary fibrosis) to report the practitioner’s diagnosis. When you look below J84.112 in the ICD-10-CM code set, there are two additional conditions that can be documented that you would report with this code:

• Cryptogenic fibrosing alveolitis
• Idiopathic fibrosing alveolitis

In the ICD-10-CM Alphabetic Index, look for Alveolitis > fibrosing (cryptogenic) (idiopathic), which provides you with J84.112. You’ll then verify the code in the Tabular List.

Condition defined: Pulmonary fibrosis refers to a situation where the lung tissue, particularly deep within the lungs, progressively develops scars. As the lung tissue becomes scarred, it thickens and stiffens, potentially causing breathing difficulties for the patient and possibly resulting in inadequate oxygenation of the blood. When the origin of this condition is unknown, it is diagnosed as idiopathic pulmonary fibrosis.

Lindsey Bush, BA, MA, CPC, Development Editor, AAPC