# re; subcutaneous emphysema



## Ms.M (Apr 5, 2010)

Hi,

I would like to know how you would code subcutaneous emphysema. Report states subcutaneous emphysema, but if you go to the icd 9 book it takes you to 958.7 (traumatic) or theres another option of coding 518.1. Which one would you code? Because for me i don't feel comfortable coding 958.7 because it's not stating it's traumatic.

Thank you,


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## jbaird (Apr 6, 2010)

Usually I see this on a post procedure chest x-ray and I code 998.81.  I would choose the 518.1 if trauma is not indicated in the report and this is not post surgery.  Can you get more information from the physician to make a final decision?


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## Ms.M (Apr 8, 2010)

Hi Jill,

Thanks for your reply but here is the report ;

CT chest, noncontrast

Indication: Pneumothorax and subcutaneous emphysema, reinsertion of
small caliber chest tube with Heimlich valve
Spiral CT of the chest was obtained without contrast. There is a right
pneumothorax of approximately 50% with extensive subcutaneous
emphysema.

The skin was marked, then prepped and draped in the usual sterile
fashion. Local anesthetic was injected through the chest wall. A small
incision was made to allow for passage of the Heimlich valve catheter.

The catheter was introduced and its position within the pleural space
was confirmed. Suction was applied. There was partial reinflation of
the right lung, and approximately 250 cc of serous fluid was removed.

The Heimlich valve appeared to be working However, the lung did not
completely expand on followup CT.

Impression:
Heimlich valve replacement with incomplete reexpansion of the right
lung. Extensive subcutaneous and mediastinal air is noted.

Severe bilateral interstitial and airspace disease 

Thank you,


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## tmlbwells (Apr 8, 2010)

I would use the 998.81 in this case.


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## Ms.M (Apr 12, 2010)

*re;*

Thank you very much!


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