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Rhonchi??

  1. #1
    Default Rhonchi??
    Medical Coding Books
    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.

  2. Default
    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..

  3. #3
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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

    Debra A. Mitchell, MSPH, CPC-H

  4. Default
    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.

  5. Default
    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.

  6. #6
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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.

    Debra A. Mitchell, MSPH, CPC-H

  7. Default
    Ok, Thanks Debra, duly noted.

  8. #8
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    Quote Originally Posted by TracyAlder View Post
    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.
    Arlene J. Smith, CPC, CPMA, CEMC, COBGC

  9. #9
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    Quote Originally Posted by ajs View Post
    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?

  10. #10
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    Tacoma, WA
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    Quote Originally Posted by TracyAlder View Post
    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!
    Arlene J. Smith, CPC, CPMA, CEMC, COBGC

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