Wiki Rhonchi??

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Code: J90

Code Name: ICD-10 Code for Pleural effusion, not elsewhere classified

Block: Other diseases of the pleura (J90-J94)

Details: Pleural effusion, not elsewhere classified
Encysted pleurisy
Pleural effusion NOS
Pleurisy with effusion (exudative) (serous)

Excludes 1: chylous (pleural) effusion (J94.0)
malignant pleural effusion (J91.0))
pleurisy NOS (R09.1)
tuberculous pleural effusion (A15.6)

Guidelines: Diseases of the respiratory system (J00-J99)
Use additional code, where applicable, to identify:exposure to environmental tobacco smoke (Z77.22)
exposure to tobacco smoke in the perinatal period (P96.81)
history of tobacco use (Z87.891)
occupational exposure to environmental tobacco smoke (Z57.31)
tobacco dependence (F17.-)
tobacco use (Z72.0)


Note: When a respiratory condition is described as occurring in more than one site and is not specifically indexed, it should be classified to the lower anatomic site (e.g. tracheobronchitis to bronchitis in J40).

Excludes 2: certain conditions originating in the perinatal period (P04-P96)
certain infectious and parasitic diseases (A00-B99)
complications of pregnancy, childbirth and the puerperium (O00-O9A)
congenital malformations, deformations and chromosomal abnormalities (Q00-Q99)
endocrine, nutritional and metabolic diseases (E00-E88)
injury, poisoning and certain other consequences of external causes (S00-T88)
neoplasms (C00-D49)
smoke inhalation (T59.81-)
symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R94)

For more details on J90, ICD-10 Code for Pleural effusion, not elsewhere classified , visit: https://coder.aapc.com/icd-10-codes/

TracyAlder

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Could someone please tell me the code they use for "rhonchi"? I'm thinking 786.7 (abnormal chest sounds), but I can't get a consensus in my office. Thank you!

PS I'm doing CRG coding so I have to pick up everything; symptoms and diagnoses alike.
 
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Rhonchi is caused by partial obstruction of the bronchial and/or aveoli with secretions.

So I would use code 519.8 (Other diseases of respiratory system, not elsewhere classified)

Hope this helps..:)
 

mitchellde

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just because someone has ronchi does not mean they have a disease of the lung, it is a symptom so stick with a symptom code. We cannot give the patient a dx not rendered by the physician and one the patient does not have. What is CRG coding and why must you code all the symptoms even one such as ronchi? Ihave never heard of this
 
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CRG coding is similar to DRG coding. CRG's are Clinical Risk Groups. It is a system that helps predict the amount and type of healthcare services that individuals should have used in the past or can be expected to use in the future. CRG's help to manage financial risk and ensure the delivery of quality healthcare to individuals based on their needs and health status.
 
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The reason I used code 519.9 (Unspecified disease of respitatory system) is because the meaning of this code is so broad and I was looking at what would be the cause of rhonchi which directed me to a number of respiratory diseases as follows:

Rhonchi: Medical causes
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Acute respiratory distress syndrome Fluid accumulation with acute respiratory distress syndrome (ARDS) — a life-threatening disorder — produces rhonchi and crackles. Initial features include rapid, shallow respirations and dyspnea, sometimes after the patient's condition appears stable. Developing hypoxemia leads to intercostal and suprasternal retractions, diaphoresis, and fluid accumulation. As hypoxemia worsens, the patient displays increased difficulty breathing, restlessness, apprehension, decreased level of consciousness, cyanosis, motor dysfunction and, possibly, tachycardia.

Aspiration of a foreign body A retained foreign body in the bronchi can cause inspiratory and expiratory rhonchi and wheezing due to increased secretions. Diminished breath sounds may be auscultated over the obstructed area. Fever, pain, and cough may also occur.

Asthma An asthma attack can cause rhonchi, crackles and, commonly, wheezing. Other features include apprehension, a dry cough that later becomes productive, prolonged expirations, and intercostal and supraclavicular retractions on inspiration. The patient may also exhibit increased accessory muscle use, nasal flaring, tachypnea, tachycardia, diaphoresis, and flushing or cyanosis.

Bronchiectasis Bronchiectasis causes lower-lobe rhonchi and crackles, which coughing may help relieve. Its classic sign is a cough that produces mucopurulent, foul-smelling and, possibly, bloody sputum. Other findings include fever, weight loss, exertional dyspnea, fatigue, malaise, halitosis, weakness, and late-stage clubbing.

Bronchitis Acute tracheobronchitis produces sonorous rhonchi and wheezing due to bronchospasm or increased mucus in the airways. Related findings include chills, sore throat, a low-grade fever (rising up to 102° F [38.9° C] in those with severe illness), muscle and back pain, and substernal tightness. A cough becomes productive as secretions increase.
With chronic bronchitis, auscultation may reveal scattered rhonchi, coarse crackles, wheezing, high-pitched piping sounds, and prolonged expirations. An early hacking cough later becomes productive. The patient also displays exertional dyspnea, increased accessory muscle use, barrel chest, cyanosis, tachypnea, and clubbing (a late sign).

Emphysema Emphysema may cause sonorous rhonchi, but faint, high-pitched wheezing is more typical, together with weight loss, exertional dyspnea, accessory muscle use on inspiration, tachypnea, grunting expirations, and a mild, chronic, productive cough with scant sputum. Other features include anorexia, malaise, barrel chest, peripheral cyanosis, and late-stage clubbing.
Pneumonia Bacterial pneumonias can cause rhonchi and a dry cough that later becomes productive. Related signs and symptoms — shaking chills, high fever, myalgias, headache, pleuritic chest pain, tachypnea, tachycardia, dyspnea, cyanosis, diaphoresis, decreased breath sounds, and fine crackles — develop suddenly.

I do agree that it is a symptom of a respiratory disorder which still brings me to code 519.9.
 

mitchellde

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519.9 is nota symptom it is a disease code for a disease not yet specified by other code or description. That is why there are codes for symptoms. The provider has not stated that any lung disease or disorder exists, asa coder we cannot assign one based on a textbook definition of what a key word could indicate.
 

ajs

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Could someone please tell me the code they use for "rhonchi"? I'm thinking 786.7 (abnormal chest sounds), but I can't get a consensus in my office. Thank you!

PS I'm doing CRG coding so I have to pick up everything; symptoms and diagnoses alike.
It would also help if you included the sentence that the symptom was included in. Too often we just get a word someone wants a dx code for, but it could mean many things depending on what else what described in the medical record around that word.
 

TracyAlder

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It would also help if you included the sentence that the symptom was included in. Too often we just get a word someone wants a dx code for, but it could mean many things depending on what else what described in the medical record around that word.
You're right about that! Unfortunately, the sentence doesn't say much:
Under Review of Systems:Respiratory: Denies shortness of breath, dyspnea, orthopnea, coughing. Rhonchi, rales present.

I thought perhaps I should use 786.7 (abnormal chest sounds) but the person who overreads me says I shouldn't because the note doesn't state "abnormal". What is everyone's opinion on that?
 

ajs

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You're right about that! Unfortunately, the sentence doesn't say much:
Under Review of Systems:Respiratory: Denies shortness of breath, dyspnea, orthopnea, coughing. Rhonchi, rales present.

I thought perhaps I should use 786.7 (abnormal chest sounds) but the person who overreads me says I shouldn't because the note doesn't state "abnormal". What is everyone's opinion on that?
The doctor has not diagnosed anything with that statement. That is just part of the medical history. You need to go with what the assessment of the patient was after the doctor reviewed all this information. And it does not say anything is abnormal so you cannot diagnose abnormal chest sounds...it might have been normal for this patient!
 

TracyAlder

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The doctor has not diagnosed anything with that statement. That is just part of the medical history. You need to go with what the assessment of the patient was after the doctor reviewed all this information. And it does not say anything is abnormal so you cannot diagnose abnormal chest sounds...it might have been normal for this patient!
Thank you very much for responding, Arlene; I appreciate your help! Remember, though, that I'm doing CRG coding so I have to pick up every little symptom. Aren't rhonchi by their nature an abnormal sound? Would it ever be considered normal to have them?
 

ajs

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Thank you very much for responding, Arlene; I appreciate your help! Remember, though, that I'm doing CRG coding so I have to pick up every little symptom. Aren't rhonchi by their nature an abnormal sound? Would it ever be considered normal to have them?
That is a question for the provider. This is what I found online as a description:

"Rhonchi are also described as "continuous" sounds. They are lower in pitch than wheezes and have a snoring quality. They also have a sinusoidal pattern on waveform, but the number of deflections per unit time is less than that of wheezes as they are of lower frequency. Although rhonchi are almost always due to airway secretions and usually clear with cough, they may be present in other conditions that cause airway narrowing."
 
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