Pulmonology Coding Alert

Question: We had a patient recently who complained of a bloated feeling in his chest. Our pulmonologist diagnosed it as Pneumothorax. We have been coding it as 512.x. How will it convert to ICD-10?

New York Subscriber

Answer: When a patient experiences accumulation of air or gas in the pleural space, which may occur spontaneously or as a result of trauma or a pathological process, the pulmonologist would likely detect a pneumothorax diagnosis. You are correct in coding it with the ICD-9 code 512.x (Pneumothorax).

ICD-10transition: When we transfer our system to ICD-10 in the coming years, you will change your pneumothorax coding from 512.x to J93.- (Pneumothorax). The important change is that there are now four further classifications under J93.- that describe the condition in greater detail. The sub-codes are J93.0 (Spontaneous tension pneumothorax), J93.1 (Other spontaneous pneumothorax), J93.8 (Other pneumothorax and air leak), and J93.9 (Pneumothorax, unspecified).

Be very attentive to the type of pneumothorax identified in the documentation of the physician. Also remember that code J93.- does not include other common forms of the condition such as post-procedural pneumothorax (J95.81), traumatic pneumothorax (S27.0), etc.

Coder tips: Even ICD-9 coding for pneumothorax has undergone a makeover. A fifth digit expansion was added post 2012 for further classifying spontaneous pneumothorax. 

Under ICD-9 2011, you used to report 512.8 (Other spontaneous pneumothorax) to report an acute, chronic, or NOS pneumothorax. From 2012 onward, you choose from a range of five-digit 512.8x codes including:

• 512.81 -- Primary spontaneous pneumothorax
• 512.82 -- Secondary spontaneous pneumothorax 
• 512.83 -- Chronic pneumothorax.

Tip: After ICD-10 transition, all these ICD-9 codes will be assimilated under J93.-