ICD 10 Coding Alert

Hint: Choose from different codes for edema due to a cardiac cause.

Frequently, your pulmonologist will rule out a cardiac condition causing pulmonary edema -- you will need to be thoroughly aware of how to report a diagnosis of unspecified edema of the lung using ICD-10 codes to utilize them when this coding system comes into use Oct. 1, 2014.

Choose From Two Different Codes Depending on Chronicity in ICD-9

In ICD-9, you will have to choose the code depending on whether the unspecified pulmonary edema is acute or chronic. If your pulmonologist confirms that the condition is acute, you will have to report the diagnosis with 518.4 (Acute edema of lung unspecified). For chronic unspecified pulmonary edema, you have to choose a totally different code, 514 (Pulmonary congestion and hypostasis).

Reminder: You will have to choose from these diagnosis codes only if the condition is due to an unspecified cause. If the condition has resulted due to a heart disease or from heart failure, you will have to choose 428.1 (Acute edema of lung with heart disease NOS or heart failure).

Observe Descriptor Changes in ICD-10

When ICD-10 codes come into effect, your reporting a diagnosis of unspecified pulmonary edema will still be based on identifying if the condition is acute or chronic. However, the condition will be represented by a common parent code, J81 (Pulmonary edema). Again, you cannot report pulmonary edema caused due to heart disease NOS (I50.1, Pulmonary edema with heart disease NOS) or heart failure (I50.1, Pulmonary edema with heart failure) or caused to external agents (J60 -- J70) with J81.

Depending on acute or chronic state of the condition, J81 will further expand into the following two codes:

• J81.0 -- Acute pulmonary edema
• J81.1 -- Chronic pulmonary edema

Coding Tip: The descriptors to unspecified pulmonary edema in the ICD-10 system will become more simplified and straightforward enabling you to choose the apt code eliminating any kind of confusion that was more likely when you had to choose a code using the ICD-9 code sets.

Check on These Specifics in Documentation

When your pulmonologist notes a diagnosis of unspecified pulmonary edema, some of the symptoms that you are more likely to come across in the documentation of the patient will include dyspnea (R06.00, Dyspnea, unspecified); tachypnea (R06.82, Tachypnea, not elsewhere classified); wheezing (R06.2, Wheezing); pallor (R23.1 Pallor); weakness (R53.1, Weakness) and excessive sweating (R61, Generalized hyperhidrosis).

Your pulmonologist will record a thorough medical history of the patient and will perform a thorough physical examination. He might note crackles or rales heard upon auscultation. If your pulmonologist suspects a diagnosis of pulmonary edema, he will order for a chest x-ray and will order for an electrocardiogram to rule out a heart condition causing the edema. A blood sample will usually be drawn to check BNP levels, CBC and to undertake kidney function tests. An arterial blood sample will also be taken by your pulmonologist to check arterial blood gases to know the levels of carbon dioxide and oxygen.

To check wedge pressure in the pulmonary artery, your pulmonologist might pass a Swan-Ganz catheter into the pulmonary artery. This procedure will help in identifying whether the edema is due to a cardiac cause or due to some other cause.

Based on results of the above mentioned tests and x-rays, if your pulmonologist rules out a cardiac cause for the pulmonary edema, you will have to report the diagnosis as unspecified pulmonary edema of the lung.

Example: Your pulmonologist assesses a 61-year-old male patient for complaints of severe dyspnea and tachypnea. The patient also complains of increasing incidence of weakness and wheezing.

Your pulmonologist performs a thorough recording of the patient’s history and then proceeds to perform a thorough examination of the patient. He observes skin pallor in the documentation and notes crackling sounds heard on auscultation.

He orders for a chest x-ray and withdraws an arterial and venous blood sample and sends it to the lab for arterial blood gases, CBC and to check BNP levels. He also undertakes pulmonary artery catheterization using a Swan-Ganz catheter to check if there is a cardiac cause for the symptoms the patient is experiencing. He records a wedge pressure less than 18mmHg thus ruling out a cardiac cause for edema. The BNP levels of less than 100 further confirms that the patient has no cardiac condition that is inducing pulmonary edema.

Coding: You report the evaluation of the patient with 99222 (Initial hospital care, per day, for the evaluation and management of a patient, which requires these 3 key components…), 93503 (Insertion and placement of flow directed catheter [e.g., Swan-Ganz] for monitoring purposes) for the pulmonary artery catheterization and report the diagnosis with J81.0 if you are using ICD-10 and 518.4 if you are using ICD-9 codes.