Otolaryngology Coding Alert

Heads up: Watch for varying definitions among groups. 

Sinusitis is a common condition for otolaryngologists to treat, but all situations are not the same. Get a firm understanding of the different types of sinusitis, then take a look at how you’ll report them when ICD-10 goes into effect. 

Be Aware of Differing Definitions

The two main classifications of sinusitis are “acute” and “chronic.” Some health groups, such as the NIH National Institute of Allergy and Infectious Disease, also specify categories for “subacute” and “recurrent.” The NIH definitions are as follows: 

• Acute – lasts up to four weeks 
• Subacute – lasts four to 12 weeks 
• Recurrent – several sinus attacks within a year 
• Chronic – lasts more than 12 weeks and can continue for months or years. 

The Academy of Otolaryngology-Head and Neck Surgery has a more detailed interpretation of acute and chronic: 

• Acute – up to four weeks of purulent nasal drainage accompanied by nasal obstruction, facial pain/pressure/fullness, or both 
• Chronic – infection lasts three or more months. 

The Cleveland Clinic has another set of definitions for providers who are interested: 

• Acute – symptoms of less than four weeks’ duration 
• Subacute – symptoms of four to eight weeks’ duration 
• Recurrent acute – three or more episodes a year, with each episode lasting less than two weeks 
• Chronic – symptoms lasting longer than eight weeks. 

What it means for you: From a coding perspective, all the opinions on terminology might not mean much because ICD-9 and ICD-10 divide diagnoses between acute and chronic. However, it’s helpful to be aware of the explanations in case your physician includes those details in his documentation – and because it can change the diagnosis once you begin coding by ICD-10. 

ICD-10 Allows for ‘Acute Recurrent’ Codes

When your physician diagnoses acute sinusitis today, you only need to know the affected sinus in order to choose the correct code. Code family 461.x represents acute sinusitis, with the fourth digit specifying the location: 

• 461.0 – Acute maxillary sinusitis 
• 461.1 – Acute frontal sinusitis
• 461.2 – Acute ethmoidal sinusitis
• 461.3 – Acute sphenoidal sinusitis 
• 461.8 – Other acute sinusitis 
• 461.9 – Acute sinusitis, unspecified.

ICD-10 difference: The new ICD-10 codes expand to five digits under J01 (Acute sinusitis) and specify when the patient has recurrent acute sinusitis. As an example, you’ll report acute maxillary sinusitis as either J01.00 (Acute maxillary sinusitis, unspecified) or J01.01 (Acute recurrent maxillary sinusitis). 

If your physician doesn’t specify the particular sinus, you’ll report either J01.90 (Acute sinusitis, unspecified) or J01.91 (Acute recurrent sinusitis, unspecified). 

Take note: All diagnoses under J01 include conditions such as acute abscess, empyema, infection, inflammation, or suppuration of the sinus. Be sure to choose an additional code from B95-B97 to identify the infectious agent.

Another change: Under ICD-9, you report pansinusitis as an “other specified” condition with 461.8. You’ll have two specific codes for it in ICD-10: J01.40 (Acute pansinusitis, unspecified) and J04.41 (Acute recurrent pansinusitis). Report acute sinusitis involving more than one sinus – but not pansinusitis – with ICD-10 code J01.80 or J01.81. The other category includes two sinuses, but not the three sinuses needed to qualify for pansinusitis

Chronic Sinusitis Coding Will Stay Simple 

ICD-9 coding for chronic sinusitis mirrors the structure for acute sinusitis: a series of four-digit codes based on the affected sinus area. They are: 

• 473.0 – Chronic maxillary sinusitis 
• 473.1 – Chronic frontal sinusitis
• 473.2 – Chronic ethmoidal sinusitis 
• 473.3 – Chronic sphenoidal sinusitis 
• 473.8 – Other chronic sinusitis 
  
• 473.9 – Unspecified sinusitis (chronic). 

Good news: Almost all chronic sinusitis codes are a direct shift to their ICD-10 interpretations. For example, 473.0 for chronic maxillary sinusitis translates to J32.0 (Chronic maxillary sinusitis). 

The only addition to the chronic sinusitis code family in ICD-10 will be J32.4 (Chronic pansinusitis). 

The J32 (Chronic sinusitis) code group will apply to diagnoses of sinus abscess, empyema, infection, or suppuration. Instructional notes for ICD-10 direct you to submit an additional code to indentify several situations involving tobacco use. For example, you would also report Z57.31 (Occupational exposure to environmental tobacco smoke) if your physician believes this contributes to the patient’s chronic sinusitis. 

You can report both acute and chronic conditions together in ICD-10, so a patient can be diagnosed with both acute sinusitis and chronic sinusitis. The acute condition should be ordered first, with the chronic condition ordered second.

Bottom line: Although ICD-10 will include some additional diagnoses for acute and chronic sinusitis, your physician should already be noting the relevant details in his patients’ charts. That means your practice hopefully is already prepared for any documentation you’ll need to select the more detailed codes.