ED Coding and Reimbursement Alert

Question: Our ED physician documented a patient in “respiratory distress.” Which code should we report for this?

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Answer: Initial encounters with patients suffering from respiratory distress don’t always conclude with an authoritative diagnosis, which means you will often end up bypassing the J00-J99 (Diseases of the Respiratory System) codes in favor of choosing a sign or symptom from the R00-R09 (Symptoms and signs involving the circulatory and respiratory systems) code block.

But be careful when you do, as some symptom and sign codes that look like respiratory conditions may not be so. For example, you would only use R07.0 (Pain in throat) if the pain could not be identified as a disease relating to the respiratory system. Otherwise, you would use a more specific diagnosis, such as J31.2 (Chronic pharyngitis) or J02.9 (Acute pharyngitis, unspecified).

Similarly, you would only use R06.2 (Wheezing) if any of the respiratory system disease codes such as J44- (Other chronic obstructive pulmonary disease), J45- (Asthma), or any of the J40-J42 bronchitis codes are not warranted.