Pulmonology Coding Alert

Question: I have a report where the provider diagnosed the patient with immunotherapy-induced pneumonitis. The record indicates the patient had been on Keytruda for their cancer treatments, but the provider stopped the immunotherapy drug following the pneumonitis.

What codes should I assign to report this encounter?

Minnesota Subscriber

Answer: Based on the information you’ve provided, you’ll assign J70.4 (Drug-induced interstitial lung disorders, unspecified) to report the pneumonitis because of the immunotherapy treatment. However, if the provider’s documentation specifically includes “acute” in the diagnosis, then you’d assign J70.2 (Acute drug-induced interstitial lung disorders). According to a 2019 AHA Coding Clinic® for ICD-10-CM article, “If the condition is not specified as acute, assign code J70.4, rather than code J70.2.”

This code also features a Use additional code note instructing you to identify the applicable drug. In this case, you noted the provider was administering Keytruda to treat the patient’s cancer, but stopped the drug once the provider identified the medication as the cause of the pneumonitis. You’ll assign T45.1X5A (Adverse effect of antineoplastic and immunosuppressive drugs, initial encounter) as the additional code to indicate the immunotherapy drug as the cause of the patient’s condition.

You’ll use the adverse effect code when the drug has been correctly prescribed and properly administered.