Otolaryngology Coding Alert

Take other factors into consideration when coding sinusitis.

Common sense might suggest that if the term chronic is not present, then you will code sinusitis as acute. However, when you’re coding ICD-10, you go where the index tells you to go. And, as any coder knows, the index can only take you so far when it comes to particular diagnoses. Let’s take a look at a few scenarios:

Indication: Sinusitis

With no specifying indicator, this one will defer to the default sinusitis code:

• J32.9, Chronic sinusitis, unspecified

While there are clearly no indications that the sinusitis is, in fact, chronic, ICD-10 tells us to code any unspecified documented sinusitis as such.

Indication: Sinusitis for eight weeks

Here, we’ve got a timeframe, but nothing else to consider when choosing a code. In this case, it’s important to know the rules pertaining to when acute sinusitis becomes chronic. According to the American Academy of Otolaryngology, acute sinusitis is “diagnosed when symptoms last up to 4 weeks.” Chronic sinusitis, on the other hand, “lasts for 12 weeks or longer.” With this information at hand, we can decisively code this indicating diagnosis as acute sinusitis:

• J01.90, Acute sinusitis, unspecified

Indication: Acute, recurrent ethmoid and maxillary sinusitis

You need to analyze this example from two different perspectives. First, we know that it’s an acute, recurrent form of sinusitis. Second, we know that we’re dealing with sinusitis of the ethmoid and maxillary sinuses. This diagnosis offers a great lesson in making sure to read each term listed under your indexed diagnosis before reaching any presumed diagnostic conclusion.

In this case, you might instinctively head immediately towards Sinusitis à acute à ethmoidal/maxillary à recurrent. However, if you scroll a little bit further down, you’ll see the correct route is to bypass acute and head straight for “involving more than one sinus, but not pansinusitis.” You’ll then reach acute à recurrent, arriving at:

• J01.81, Acute, recurrent sinusitis involving more than one sinus but not pansinusitis

Know When to Code Pansinusitis

In the field of medical coding, your skillset and knowledge can only take you as far as the physician’s dictation allows. This is particularly applicable when it comes to ICD-10 coding. The wording behind a particular diagnosis can go a long way in making a coder’s job exponentially easier. This rule applies to sinus disease coding among numerous other anatomical structures.

We just covered the example of if sinusitis was documented in more than one sinus, but not in all four — but what the provider separately documents sinusitis in all four sinuses, but does not reference the term “pansinusitis”? It’s instances like these where an » established relationship between coder and physician can go a long way. However, if you do find yourself this particular coding predicament, you’ve got the option of going in one of two directions.

The first option is to code the indicating diagnosis as pansinusitis, since it technically reaches the clinical definition of pansinusitis. The other option would be to code each sinusitis diagnosis separately.

The decision might be made easier for you if the degrees of sinusitis vary between chronic and acute (in which case you’d code individually), but that is unlikely to be the case in most circumstances. So, which is the correct route?

“Care needs to be taken when coding sinusitis,  because it is one of the few codes in ICD-10 that defaults to chronic,” explains Lindsay Della Vella, COC, medical coding auditor at Precision Healthcare Management in Media, Pennsylvania. “If sinusitis is documented on three or more sinuses unilaterally, you will apply code J32.4 (Chronic pansinusitis). All of the chronic sinusitis codes are found in the J32- section of the ICD-10 index, which falls under the subsection‘Other diseases of upper respiratory tract (J30-J39).’”

Della Vella continues to explain what situations are appropriate to code pansinusitis as acute. “Similarly, if the acute sinusitis is documented in three or more sinuses unilaterally, the same logic applies. It is still coded as pansinusitis, but as acute pansinusitis, which falls under code J01.4- [Acute pansinusitis …].” You can find the acute sinusitis codes under the subsection Acute upper respiratory infections (J00-J06) in ICD-10.