Pulmonology Coding Alert

More than 50% of truck drivers smoke cigarettes.

If your pulmonologist sees a patient who works as a truck driver, then you know you’ll likely be reporting codes related to smoking or sleep apnea. Are you confident you can code these conditions correctly?

If you want to be certain your claims make the grade, then check out these ICD-10-CM coding intricacies, brought to you by Sarah Ragan, COC, CPC, CPMA, CRC, CFPC, President of the Daytona Beach AAPC Chapter and Jake Ragan, CDL-A, CDL Instructor, who presented “Health Conditions of the American Trucker” at the recent Regional HEALTHCON conference in Charleston, S.C.

Understand What Life is Like on the Open Road

A truck driver can spend most of the year on the road and away from their families and friends. They’re permitted to work up to a total of 14 hours a day, which can be a combination of driving and loading and unloading the truck. If a driver works 14 hours straight, they must take a 10-hour break according to federal law (URL: www.fmcsa.dot.gov/regulations/hours-service/summary-hours-service-regulations).

While on the road, truck drivers have few options available to access healthy food, and most rest stops only have fast food options. These grab-and-go choices are typically high in calories and fat. The drivers also come across severe weather conditions that can cause delays or detours on their routes.

Drivers do have the benefit of visiting many sites around the country, earning a decent living, and meeting a lot of new people. However, the stress and health issues that accrues slowly over time can become too much to handle.

Re-Ignite Your Cigarette Smoking Coding Skills

Individuals often smoke cigarettes as a stress release, and while the efforts of smoking cessation public service campaigns, literature, and education have reduced cigarette smoking with the general public, more than 50% of commercial drivers smoke cigarettes (URL: pubmed.ncbi.nlm.nih.gov/24390804/). If a patient is referred to your pulmonology practice due to conditions that could be exacerbated by smoking, you’ll consult the F17.- (Nicotine dependence) code family, which includes F17.200 (Nicotine dependence, unspecified, uncomplicated) and F17.210 (…, cigarettes, uncomplicated), to document the possible cause of the condition on your claim.

What about truck drivers who use vaping products? “When I do have vaping, right now I’m using F17.290, but I suspect that eventually there’s going to be something else for us to be following,” Ragan says. If your physician’s documentation indicates the patient uses a vaping product, you can use F17.290 (Nicotine dependence, other tobacco product, uncomplicated), as there currently isn’t a specific vaping-related coding option in the ICD-10-CM code set.

“There’s a code for vaping-related disorder, but not actually for vaping itself, it’s in the U [section],” Ragan says. Section I.C.10.e of the ICD-10-CM guidelines instructs you to use U07.0 (Vaping-related disorder) for patients presenting symptoms related to vaping as the principal diagnosis. However, if your patient experiences a lung injury due to vaping, then you’ll assign U07.0 and additional codes “for other manifestations.”

Be Aware that Drowsiness and Diesel Don’t Mix

Due to the nature of the job and the limited food options while traveling, most drivers tend to be obese. When a patient has their BMI calculated and documented at an evaluation and management (E/M) visit, you’ll use E66.3 (Overweight), E66.9 (Obesity, unspecified), or E66.01 (Morbid (severe) obesity due to excess calories) to document their condition.

Important: A portion of ICD-10-CM guideline I.C.21.c.3 states, “BMI codes should only be assigned when there is an associated, reportable diagnosis (such as obesity).” Therefore, you should only document the patient’s BMI if the condition is specifically listed in the provider’s documentation.

Obesity can also lead to other conditions such as obstructive sleep apnea (G47.33 Obstructive sleep apnea (adult) (pediatric)), which is frequently written in reports as OSA. OSA is an intermittent airflow blockage while the patient sleeps, and symptoms can include snoring (R06.83 Snoring) and daytime sleepiness (R40.0 Somnolence). Prior to an OSA diagnosis, the patient will be commonly diagnosed for the signs and symptoms first. “If the provider documents OSA, we’re not supposed to code the symptoms because it’s included with the diagnosis,” Ragan says. A poor night’s rest can make long shifts behind the wheel feel even longer.

Following an OSA diagnosis, a patient may be prescribed a CPAP or BiPAP device. A CPAP (E0601, Continuous positive airway pressure (CPAP) device) produces a positive airflow current through the nose to help maintain an open airway while the patient sleeps, whereas a BiPAP device cycles between two levels of air pressure during operation.