ICD 10 Coding Alert

Type of inhaled inorganic dust is vital for accurate coding.

If your pulmonologist treats patients with occupational respiratory problems, you're likely to see pneumoconiosis diagnoses fairly frequently. Get a head start on coding this condition when ICD-10 codes come into effect by reviewing the advice below.

Check for These Symptoms and Tests

Some common symptoms that you are most likely to see in the documentation of a patient suffering from pneumoconiosis will include shortness of breath (R06.02, Shortness of breath), cough (R05, Cough), chest pain, difficulty in breathing (R07.1, Chest pain on breathing), wheezing (R06.2, Wheezing) and swelling in the feet (R60.9, Edema, unspecified).

Your pulmonologist might order certain lab tests such as blood gases (82805, Gases, blood, any combination of pH, pCO2, pO2, CO2, HCO3 [including calculated O2 saturation]; with O2 saturation, by direct measurement, except pulse oximetry), sputum smear to check if the patient has tuberculosis and certain immune assays (86001, Allergen specific IgG quantitative or semiquantitative, each allergen).

Some diagnostic tests such as tuberculin skin test (86580, Skin test; tuberculosis, intradermal), chest x-rays (71020, Radiologic examination, chest, 2 views, frontal and lateral) and bronchoscopy (31622, Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; diagnostic, with cell washing, when performed [separate procedure]) or bronchoscopy with lavage (31624, Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with bronchial alveolar lavage) performed by your pulmonologist will also help in arriving at the diagnosis.

Your pulmonologist might also depend on pulmonary function tests such as spirometry (94010, Spirometry, including graphic record, total and timed vital capacity, expiratory flow rate measurement[s], with or without maximal voluntary ventilation), determination of lung volumes (94727, Gas dilution or washout for determination of lung volumes and, when performed, distribution of ventilation and closing volumes) and respiratory flow volume (94375, Respiratory flow volume loop) to seal the diagnosis of pneumoconiosis.

Reporting Pneumoconiosis in ICD-9

Based on the type of inorganic dust, the diagnosis of pneumoconiosis is reported using codes 500 to 503. Coal worker's pneumoconiosis is reported using 500 (Coal workers' pneumoconiosis), asbestosis with 501 (Asbestosis), silicosis and talcosis with 502 (Pneumoconiosis due to other silica or silicates) all other forms of pneumoconiosis with 503 (Pneumoconiosis due to other inorganic dust) and unspecified pneumoconiosis with 505 (Pneumoconiosis unspecified).

Note More Specificity in ICD-10

When ICD-10 comes into effect, the descriptors to coal worker's pneumoconiosis (J60, Coalworker's pneumoconiosis) and unspecified pneumoconiosis (J64, Unspecified pneumoconiosis) remain the same. The descriptor to asbestosis is altered and you would report the condition using J61 (Pneumoconiosis due to asbestos and other mineral fibers).

However, the main change is that 503 that used to cover pneumoconiosis due to other inorganic dusts transforms into J63.x under ICD-10 that further expands to 7 different codes using the fourth digit depending on the type of specific inorganic dust that is inhaled. So, the list now includes:

• J63.0 (Aluminosis [of lung])
• J63.1 (Bauxite fibrosis [of lung])
• J63.2 (Berylliosis)
• J63.3 (Graphite fibrosis [of lung])
• J63.4 (Siderosis)
• J63.5 (Stannosis)
• J63.6 (Pneumoconiosis due to other specified inorganic dusts)

Example: A male patient arrives at your pulmonologist's practice with symptoms of cough, wheezing, dyspnea and edema in the feet. Your pulmonologist takes complete patient history and performs a thorough evaluation of the patient. The occupational history of the patient reveals that he works in a coal mine.

Upon further tests, chest x-rays and PFT, your pulmonologist is able to confirm the diagnosis of coal workers' pneumoconiosis. You will have to report the condition with J60, along with Z57.2 (Occupational exposure to dust). You report the evaluation and management of the patient with E/M codes 99204 (Office or other outpatient visit for the evaluation and management of a new patient...).