Pulmonology Coding Alert

Coordinate history and symptoms to arrive at the right diagnosis.

Heads up, coders – the way you code for extrinsic allergic alveolitis (EAA) is changing starting in 2015.

Also known as hypersensitivity pneumonitis, EAA is inflammation in the alveoli of the lungs most commonly caused by occupational exposure to pollutants and allergens. Until now, you have coded such cases within the ICD-9 subcategory 495 – but not any longer.

Next year onward, as the system transitions to ICD-10, the subcategory to focus on will be J67 with a fourth digit for specificity. 

Farmer’s Lung: Farm workers are often occupationally exposed to moldy dusts coming from hay dust or mold spores or other agricultural products. Inhalation of this dust results in a type III hypersensitivity inflammatory response, which may progress to a potentially dangerous chronic condition. Once your pulmonologist arrives at the diagnosis of farmer’s lung, currently you report it with the ICD-9 code 495.0 (Farmers’ lung). 

Effective 2015, the ICD-10 code for farmers’ lung will change to J67.0 (Farmer’s lung). 

Bagassosis: Another example of EAA is bagassosis, which refers to the inhalation of sugarcane dust particles in an occupational setting that can lead to various lung symptoms. When a pulmonologist diagnoses a patient with this condition, you have been reporting it using the ICD-9 code 495.1 (Bagassosis).

Next year, 495.1 will directly correlate to J67.1.

Bird-fancier’s lung: Bird fanciers’ lung (BFL), also called bird-breeders’ lung and pigeon-breeders’ lung, is a subset of hypersensitivity pneumonitis. Exposure to avian proteins present in the dry dust of the droppings and sometimes in the feathers of a variety of birds causes this disease. When a pulmonologist diagnoses a patient with this disease, you have reported it using the ICD-9 code 495.2 (Bird-fanciers’ lung).

After the ICD-10 changeover, code 495.2 will change to J67.2 (Bird-fancier’s lung). You won’t see any difference to the function of the new ICD-10 code. In addition, J67.2 is applicable to budgerigar fanciers’ disease and pigeon fanciers’ disease.

Suberosis: Cork workers who are involved in harvesting and storage of cork oak (Quercus suber) are most susceptible to this disease. The workers may be exposed to organic dust, as the harvested cork is stacked in slabs in a hot and humid storage area, leading to suberosis. When your pulmonologist diagnoses suberosis, you have a straight-forward transition from ICD-9 to ICD-10 set of codes with similar set of inclusions and exclusions for the two codes. Currently, you report it with 495.3 (Suberosis) in ICD-9 codes. You use the same diagnosis code if your clinician mentions the diagnosis as cork-handlers’ disease of the lung. Currently, you also use 495.3 if the diagnosis is allergic alveolitis and pneumonitis due to inhaled organic dust particles of fungal, thermophilic actinomycete, or other origin.

When ICD-10 codes take effect next year, 495.3 in ICD-9 bridges to J67.3 (Suberosis) in ICD-10. As with ICD-9, you’ll use J67.3 if your practitioner’s diagnosis is cork-handlers’ disease of the lung or even cork-workers’ disease of the lung.

Coder tips: When the physician merely suspects that a patient has EAA, she should report the patient’s signs and symptoms in the medical documentation. The pulmonologist must take an extensive history, perform a thorough exam and order several diagnostic tests to zero in on the exact allergen. Once the pulmonologist definitively diagnoses the patient with EAA, you should code to the highest level of confirmed specificity.