ICD 10 Coding Alert

More than 50% of truck drivers smoke cigarettes.

Folks who drive trucks as a vocation often live with similar medical conditions, often related to cigarette smoking and sleep apnea.

Make sure you’re reporting the related ICD-10-CM codes correctly with these tips provided by Sarah Ragan, COC, CPC, CPMA, CRC, CFPC, president of the Daytona Beach AAPC Chapter and Jake Ragan, CDL-A, CDL instructor, who presented “Health Conditions of the American Trucker” at the October Regional HEALTHCON in Charleston, South Carolina.

Understand Truckers’ Living Conditions

A truck driver may spend most of the year on the road, away from family and friends. They’re permitted to work up to a total of 14 hours a day, which can be a combination of driving and loading and unloading the truck. If a driver works 14 hours straight, they must take a 10-hour break, according to federal law (See more here www.fmcsa.dot.gov/regulations/hours-service/summary-hours-service-regulations).

While on the road, truck drivers have few ways to access healthy food — most rest stops have fast food options only. These grab-and-go choices are typically high in calories and fat. The drivers also come across severe weather conditions that can cause delays or detours on their routes.

Drivers do have the benefit of visiting many sites around the country, earning a decent living, and meeting a lot of new people. However, the stress and health issues that accrue slowly over time can become too much to handle.

Recalibrate Your Cigarette Smoking Coding

Individuals often smoke cigarettes as a way to cope with stress. Federal agencies and various entities have conducted smoking-cessation public service campaigns, along with publishing literature and providing education, which have reduced cigarette smoking generally. Still, more than 50 percent of commercial drivers smoke cigarettes (Resource: http://pubmed.ncbi.nlm.nih.gov/24390804/).

If a patient is referred to your pulmonology practice due to conditions that could be exacerbated by smoking, you’ll consult the F17.- (Nicotine dependence) code family, which includes F17.200 (Nicotine dependence, unspecified, uncomplicated) and F17.210 (…, cigarettes, uncomplicated), to document the possible cause of the condition on your claim.

What about truck drivers who use vaping products? “When I do have vaping, right now I’m using F17.290 [Nicotine dependence, other tobacco product, uncomplicated], but I suspect that eventually there’s going to be something else for us to be following,” Ragan says. If your physician’s documentation indicates the patient uses a vaping product, you can use F17.290, as there currently isn’t a specific vaping-related coding option in the ICD-10-CM code set.

“There’s a code for vaping-related disorder, but not actually for vaping itself, it’s in the U [section],” Ragan says. Section I.C.10.e of the ICD-10-CM guidelines instructs you to use U07.0 (Vaping-related disorder) for patients presenting symptoms related to vaping as the principal diagnosis. However, if your patient experiences a lung injury due to vaping, then you’ll assign U07.0 and additional codes “for other manifestations.”

Document Sedentary Nature of Work

Due to the nature of the job and the limited food options while traveling, most drivers tend to be obese. When a patient has their body mass index (BMI) calculated and documented at an evaluation and management (E/M) visit, you’ll use E66.3 (Overweight), E66.9 (Obesity, unspecified), or E66.01 (Morbid (severe) obesity due to excess calories) to document their condition.

Important: A portion of ICD-10-CM guideline I.C.21.c.3 states, “BMI codes should only be assigned when there is an associated, reportable diagnosis (such as obesity).” Therefore, you should only document the patient’s BMI if the condition is specifically listed in the provider’s documentation.

Obesity can also lead to other conditions such as obstructive sleep apnea (G47.33 [Obstructive sleep apnea (adult) (pediatric)]), which is frequently written in reports as OSA. OSA is an intermittent airflow blockage while the patient sleeps, and symptoms can include snoring (R06.83 [Snoring]) and daytime sleepiness (R40.0 [Somnolence]). Prior to an OSA diagnosis, the patient will be commonly diagnosed for the signs and symptoms first. “If the provider documents OSA, we’re not supposed to code the symptoms because it’s included with the diagnosis,” Ragan says. A poor night’s rest can make long shifts behind the wheel feel even longer.

Following an OSA diagnosis, a patient may be prescribed a continuous positive airway pressure (CPAP) device or bilevel positive airway pressure (BiPAP) device. A CPAP (E0601 [Continuous positive airway pressure (CPAP) device]) produces a positive airflow current through the nose to help maintain an open airway while the patient sleeps, whereas a BiPAP device cycles between two levels of air pressure during operation.