Internal Medicine Coding Alert

Code J32.x with a fourth digit to specify location.

When following the ICD-9-CM code set, you report 473.x (Chronic sinusitis) for patients suffering from chronic infection of sinus if the symptoms persist despite two or more months' treatment. This condition interferes with drainage and causes mucus to build up, and is also known as rhinosinusitis, hyperplastic sinusitis, chronic rhinosinusitis, and chronic unspecified sinusitis.

ICD difference: Effective Oct. 1, 2013, you'll have several location-specific diagnoses to select among. Turn to the "J" codes of ICD-10 to report chronic sinusitis and its subcategories:

• J32.0 -- Chronic maxillary sinusitis
• J32.1 -- Chronic frontal sinusitis
• J32.2 -- Chronic ethmoidal sinusitis
• J32.3 -- Chronic sphenoidal sinusitis
• J32.4 -- Chronic pansinusitis
• J32.8 -- Other chronic sinusitis
• J32.9 -- Chronic sinusitis, unspecified.

ICD-10 retains the description of chronic sinusitis subcategories from their ICD-9 counterparts, with the addition of one subcategory J32.4, which describes chronic pansinusitis and is currently not available to us under ICD-9.

Documentation: The internist should note any symptoms of the chronic sinusitis, which may include difficulty breathing through the nose, swollen areas of the eyes and face, and throbbing facial pain or headache. Don't code the condition unless your physician specifies it on his notes, and she should pinpoint the location of the sinusitis. If the infectious agent causing the chronic sinusitis is known, you may report an additional code for that agent from the B95-B97 section of ICD-10. For both acute and chronic sinusitis, you should select the fourth digit code based on where the sinusitis occurs. Acute sinusitis (J01.x) also requires a fifth digit to indicate if it is unspecified or recurrent.