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Basic ICD-9-CM Coding2010 edition

Chapter 11: Diseases of the Respiratory System

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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

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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)

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Diseases of Respiratory System (continued)

• Pneumoconioses and other lung diseases due to external agents (500–508)

• Other diseases of the respiratory system (510–519)

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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)

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Pneumonia

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

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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!

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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)

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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

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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)

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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