Examine This Comprehensive Guide on Sarcoidosis Treatment and Coding
Find out about the Siltzbach classification system. Sarcoidosis is a condition that develops when a patient’s immune system overreacts and creates lumps or nodules called granulomas. A granuloma is inflammation that is caused by the immune system and, depending on the size, can cause mild to severe symptoms. Read on to learn about how pulmonologists diagnose and treat the condition, and how to correctly code sarcoidosis diagnoses. Understand the Diagnosis, Symptoms, and Treatment Options The granulomas may turn into fibrosis, which can lead to permanent lung scarring. Pulmonary fibrosis causes the lungs to thicken, making it hard for the patient to breathe. Even though granulomas can be found anywhere in the body, they are most commonly seen in the lungs. Although sarcoidosis affects anyone, it most commonly occurs in Black people. The condition is also more common in women than men, between the ages of 25 and 40 years old. Sarcoidosis is a rather rare disease, as there are usually less than 200,000 cases throughout the United States per year. Some of the most common symptoms are related to the lungs, but granulomas can also form on the skin, eyes, joints, or anywhere else in the body. Patients may only feel unwell with no specific symptoms. Generalized symptoms of sarcoidosis include: When sarcoidosis affects the lungs specifically, patients may report symptoms such as cough, shortness of breath, chest pain, and wheezing. Staging: Pulmonary sarcoidosis is broken down in stages based on the Siltzbach classification system. The stages are numbered 0 through 4, and only stage 4 is considered irreversible as it causes permanent lung damage. In the lower stages, granulomas can sometimes disappear on their own with no intervention needed. Here's how to understand pulmonary sarcoidosis stages: Researchers have found that both genetic and other environmental factors play a role into the development of sarcoidosis. Certain patients have a higher probability of their immune systems overreacting to certain antigens, such as bacteria or viruses. That being said, sarcoidosis is not considered an autoimmune disorder. Recognize Sarcoidosis Testing and Medications Pulmonologists don’t have a specific test they can run to diagnose sarcoidosis, but they can perform testing to rule out other conditions and see which areas of the body might be affected. Examples of testing can include blood tests, chest X-rays, CT scans, pulmonary function tests, electrocardiogram (ECG/EKG), eye exams, and positron emission tomography (PET) scans. The physician may also perform a biopsy to look for granulomas in the skin, lungs, and lymph nodes. More invasive testing options include fine needle aspiration, transbronchial biopsies, and mediastinotomy. In cases where the symptoms are severe and affect other organs, medication may be required. Medications include corticosteroids and medicines that affect the immune system (e.g., methotrexate or Azasan); hydroxychloroquine may help with skin lesions or high blood-calcium levels, and the physician might also prescribe tumor necrosis factor alpha inhibitors (TNF-alpha), which are commonly used in patients with rheumatoid arthritis. Physicians may also refer patients to physical therapy or pulmonary rehabilitation, or the provider may insert a cardiac pacemaker or defibrillator for heart-related conditions. Providers will continue to monitor the condition through testing (blood, EKG, and other exams) for the rest of the patient’s life. Symptoms can take months to years to improve. Diet modification is also recommended (e.g., eating a plant-based diet, avoiding sugar and carbohydrates, etc.). Patients may also experience complications during sarcoidosis treatment. Common complications include: Examine the Sarcoidosis Diagnosis Codes The most common sarcoidosis diagnosis codes relate to where the condition is occurring, be it the lung, lymph nodes, skin, other sites, or unspecified sites. The ICD-10-CM category for sarcoidosis is D86.- (Sarcoidosis). The key coding concepts include the site of involvement, presence of multiple sites, and clinical manifestations. Codes listed under the D86.- category are: Entries in subcategory D86.8- require a 5th character to complete the codes. These codes specify sarcoidosis occurring in other anatomical sites in the body. Examples of these codes include D86.81 (Sarcoid meningitis), D86.85 (Sarcoid myocarditis), and D86.86 (Sarcoid arthropathy). Documentation mistakes: Common documentation mistakes are failing to use the highest specificity for the site and confusion between sarcoidosis and other granuloma-related conditions. The provider documentation should include the specific site of the sarcoidosis involvement, any associated symptoms or complications, and details of any treatment or intervention performed. Check Out These Sarcoidosis Coding Scenarios Examine these two scenarios to understand how to correctly code sarcoidosis diagnoses: Scenario 1: An established patient presented to the pulmonologist’s office with respiratory symptoms. After a physical exam and other conditions were ruled out, the physician diagnosed the patient with sarcoidosis of the lungs. You’ll assign D86.0 to report the sarcoidosis of the lungs diagnosis. Scenario 2: An established patient with preexisting sarcoidosis begins to develop multiple cranial nerve palsies. Use D86.82 (Multiple cranial nerve palsies in sarcoidosis) to report the pulmonologist’s diagnosis. Remember These Best Practices for Coding Sarcoidosis Pulmonology coders, new and experienced, can always benefit from practical advice to ensure their claims are correct. Heed the following tips when reporting sarcoidosis diagnosis and treatment: Cristin Robinson, CPC, CPMA, CCC, CRC, CEMC, AAPC Approved Instructor,
Education Coding Consultant, Bristol, Tennessee
