1. © 2010 Basic ICD-9-CM Coding 2010 edition Chapter 11: Diseases of the Respiratory System

2. © 2010 2 Learning Objectives Review the chapter’s learning objectives At the conclusion of this chapter, what must you know about the coding of respiratory diseases and related procedures

3. © 2010 3 Diseases of Respiratory System Acute respiratory infections (460–466) Other diseases of upper respiratory tract (470–478) Pneumonia and influenza (480–488) Chronic obstructive pulmonary disease and allied conditions (490–496)

4. © 2010 4 Diseases of Respiratory System (continued) Pneumoconioses and other lung diseases due to external agents (500–508) Other diseases of the respiratory system (510–519)

5. © 2010 5 Bronchitis Acute bronchitis (466.0) Chronic bronchitis (491) Not specified as acute or chronic (490) –Code 490 included in the section with other chronic lung diseases Does physician mean acute when only diagnostic statement is “bronchitis?” (Probably true if the patient is a child or young adult)

6. © 2010 6 Pneumonia Pneumonia is classified by causative organism (480–486) or type of pneumonia (507) –Viral –Pneumonococcal –Bacterial –Other organisms –Aspiration

7. © 2010 7 Pneumonia (continued) Physician must document the type of pneumonia Laboratory findings (cultures, Gram stains) cannot substitute for physician documentation Patient can have both bacterial and aspiration pneumonias—code both!

8. © 2010 8 Asthma Category 493 –Also known as reactive airway disease Fourth and fifth digits describe the specific type of asthma –Extrinsic –Intrinsic –Chronic obstructive –Exercise induced bronchospasm –Cough variant asthma –Unspecified

9. © 2010 9 Asthma (continued) Fifth-digit subclassification must be added to all codes based on the documentation in the health record –0 Without mention of status asthmaticus or acute exacerbation or unspecified –1 With mention of status asthmaticus –2 With mention of acute exacerbation

10. © 2010 10 Chronic Obstructive Pulmonary Disease Codes 490–496: COPD and allied conditions Categories 491–493, 494: specific forms of COPD Category 496: unspecified form of COPD See “note” and “excludes note” under category 496

11. © 2010 11 Respiratory Failure Different forms of respiratory failure –518.81, Acute respiratory failure or respiratory failure, not otherwise specified –518.83, Chronic respiratory failure –518.84, Acute and chronic respiratory failure

12. © 2010 12 Coding and Sequencing of Respiratory Failure Respiratory failure always caused by an underlying condition It may be due to other respiratory conditions or due to diseases of other organ systems Respiratory failure never exists as a single condition Follow official coding guidelines Follow principal diagnosis rules

13. © 2010 13 Coding and Sequencing of Respiratory Failure There is not one rule for sequencing the diagnosis of respiratory failure with other conditions When a patient is admitted in respiratory failure with another acute condition, the principal diagnosis will not be the same in every situation

14. © 2010 14 Coding and Sequencing of Respiratory Failure Example 1 Patient with chronic myasthenia gravis suffers an acute exacerbation and develops acute respiratory failure Principal diagnosis: 518.81, acute respiratory failure Secondary diagnosis: 358.01, myasthenia gravis with (acute) exacerbation

15. © 2010 15 Coding and Sequencing of Respiratory Failure Example 2 Patient with emphysema develops acute respiratory failure and is admitted for treatment of the respiratory failure Principal diagnosis: 518.81, acute respiratory failure Secondary diagnosis: 492.8, emphysema

16. © 2010 16 Coding and Sequencing of Respiratory Failure Example 3 Patient with congestive heart failure is admitted to the hospital because of acute respiratory failure Principal diagnosis: 518.81, acute respiratory failure Secondary diagnosis: 428.0, congestive heart failure

17. © 2010 17 Coding and Sequencing of Respiratory Failure Example 4 Patient with asthma in status asthmaticus develops acute respiratory failure and is admitted to the hospital for treatment of the respiratory failure Principal diagnosis: 518.81, acute respiratory failure Secondary diagnosis: 493.91, asthma, unspecified, with status asthmaticus

18. © 2010 18 Coding and Sequencing of Respiratory Failure Example 5 Patient is admitted to the hospital during the postpartum period as a result of developing pulmonary embolism leading to respiratory failure Principal diagnosis: 673.24, obstetrical blood-clot embolism, postpartum condition or complication Secondary diagnosis: 518.81, acute respiratory failure

19. © 2010 19 Coding and Sequencing of Respiratory Failure Example 6 Patient is diagnosed as having overdosed on crack cocaine and is admitted to the hospital with respiratory failure Principal diagnosis: 970.8, poisoning by other specified central nervous system stimulant Secondary diagnosis: 518.81, acute respiratory failure

20. © 2010 20 Coding and Sequencing of Respiratory Failure Example 7 Patient is admitted with acute respiratory failure due to Pneumocystis carinii pneumonia which is due to AIDS Principal diagnosis: 042, human immunodeficiency virus (HIV) disease Secondary diagnoses: 518.81, acute respiratory failure and 136.3, pneumocystosis

21. © 2010 21 Coding and Sequencing of Respiratory Failure Example 8 Patient is admitted to the hospital with severe staphylococcal aureus sepsis and acute respiratory failure Principal diagnosis: 038.11, staphylococcal aureus septicemia Secondary diagnoses: 995.92, systemic inflammatory response syndrome due to infectious process with organ dysfunction and 518.81, acute respiratory failure

22. © 2010 22 Respiratory Procedures Closed endoscopic procedures –Biopsies –Excision of lesions Mechanical ventilation –Need number of hours patient is on continuous mechanical ventilation (96.7x) –Additional code(s) to describe endotracheal intubation (96.04) or tracheostomy (31.1–31.29)

23. © 2010 23 Respiratory Procedures Non-invasive respiratory assistance Delivered by face mask, nasal mask, nasal pillow, oral mouthpiece or oronasal mask Does not require endotracheal tube or tracheostomy Coded with 93.90, Non-invasive mechanical ventilation

24. © 2010 24 Respiratory Procedures Types of non-invasive respiratory assist procedures: –Continuous positive airway pressure (CPAP) –Bilevel positive airway pressure (BiPAP) –Noninvasive positive pressure ventilation (NIPPV) –Nonpositive pressure ventilation (NPPV)

25. © 2010 25 Respiratory Procedures If CPAP or BiPAP is delivered via tracheostomy or through an endotracheal tube, it is considered invasive mechanical ventilation –Use subcategory codes 96.7