Quiz Yourself on These Common Breathing Issues
Accurate respiratory coding depends heavily on provider documentation. Can you tell the difference between acute and chronic bronchitis? Do you know when a positive respiratory syncytial virus (RSV) test supports a diagnosis code? Put your respiratory coding knowledge to the test and see if you can navigate some of the most common upper respiratory coding challenges seen in pediatric offices with this quick quiz. Question 1: A child with chronic asthma comes into your pediatric office with a runny nose and cough. The pediatrician diagnoses them with a common cold and prescribes a steroid inhaler because the illness has triggered increased asthma-related coughing. Which ICD-10-CM codes are appropriate? Hint: In this scenario, you should code both the cold and the asthma, with the cold being reported as the primary diagnosis, and the asthma reported as the second. Answer: The chronic asthma in this case impacts treatment like any comorbid condition. Therefore, in this case, you’d report J00 (Acute nasopharyngitis [common cold]), then list J45.901 (Unspecified asthma with (acute) exacerbation) as the second code. Asthma severity is classified into four categories: intermittent, mild persistent, moderate persistent, and severe persistent. As you can see in the list below, these categories align with the first four subgroups within the J45.- code family, followed by the customary “other and unspecified” code option: Most of the codes in this group require a 5th character to communicate the patient’s state at the time of the encounter. You’ll sequence the cold before the asthma because the cold symptoms were chiefly responsible for the visit. The patient's asthma is an existing chronic condition, but it is reportable because it affected clinical management and required treatment considerations during the encounter. Question 2: The practitioner documented only that the patient had a cough. Are you able to code this condition based on the little information you have, or will a query be necessary? Answer: A provider query will be necessary in this case. With six available cough codes and limited documentation, there is not enough information to support code selection. The cough codes are as follows: Code selection will depend on how the provider characterizes the cough. A brief, self-limited cough is reported with R05.1, while documentation describing the cough as persistent, refractory, or unexplained points to R05.3. Assign R05.4 when forceful coughing results in a loss of consciousness. As always, review the documentation carefully and avoid unspecified codes when a more precise option is supported. Question 3: A pediatric patient presents with a productive cough and shortness of breath. After evaluation, the physician diagnoses mucopurulent chronic bronchitis and notes that the patient has experienced cough and mucus production for most days over the past three months and for two consecutive years. Which ICD-10-CM code should you assign? Answer: To choose the correct code, you’ll first need to determine whether the provider documented an acute or chronic condition. Chronic bronchitis is characterized by a cough and mucus production occurring most days for at least three months per year over two consecutive years. Next, review the type of chronic bronchitis documented. Mucopurulent chronic bronchitis differs from simple chronic bronchitis because it produces pus in addition to mucus, often resulting in thicker, cloudy, yellow, or green sputum. When the provider specifically documents mucopurulent chronic bronchitis, J41.1(Mucopurulent chronic bronchitis) is the appropriate code. If the documentation instead describes simple chronic bronchitis, you would assign J41.0 (Simple chronic bronchitis), while J41.8 (Mixed simple and mucopurulent chronic bronchitis) applies when both simple and mucopurulent chronic bronchitis are documented. Question 4: If you have a patient with a cough who also tests positive for RSV, what are the appropriate ICD-10-CM codes to use? Answer: Although choosing B97.4 (Respiratory syncytial virus as the cause of diseases classified elsewhere) may seem like the correct coding choice in this scenario, don’t assume a positive RSV test automatically supports this outcome. This code is intended to identify RSV as the cause of a condition classified elsewhere, which means the provider must document both the RSV infection and the condition it caused. The Code first instruction reinforces this sequencing requirement by directing coders to report the associated disorder first. Also note that ICD-10-CM does not include a code for a positive RSV test result in the absence of a diagnosis. When the provider has not established a definitive diagnosis or linked the RSV infection to a documented condition, you’ll instead assign codes for the patient’s signs and symptoms, following ICD-10-CM Official Guidelines sections I.B.4-I.B.6. Question 5: A 2-year-old presents to the office with a barking cough, noisy breathing, and a low-grade fever. The pediatrician documents viral croup as the cause. Should you assign a code for the viral infection in addition to the croup code? Answer: No, an additional code is typically unnecessary unless the provider documents a specific causative organism that requires separate reporting. Report croup with J05.0 (Acute obstructive laryngitis [croup]), which already captures the patient’s condition. Lindsey Bush, BA, MA, CPC, Production Editor, AAPC
