Otolaryngology Coding Alert

Your only two concerns should be manifestation and type of fungus.

Though uncommon, some sinus infections are caused by fungus. When the otolaryngologist diagnoses a patient with fungal sinusitis, a single code will not be your easy way out.

Instead, you should rely on a combination of ICD-9 codes, and a careful examination of the physician's notes for manifestations.

Scenario: A patient reports to the office complaining of severe headaches, loss of appetite and postnasal discharge into the throat. An ENT diagnoses the patient with fungal sinusitis confirmed on culture. She also notes down that a chronic ethmoidal kind of sinusitis due to aspergillosis afflicts the patient.

If you check the ICD-9 manual for a code for fungal sinusitis, you would be directed to 117.9 (Other and unspecified mycoses). But a single code may not appropriately describe the patient's condition. Here's what you should do:

1. List Manifestation As Primary Diagnosis

The initial instruction for category 110-118 (Mycoses) directs you to use additional code to identify manifestation. Mycoses pertain to any disease caused by fungi. In the scenario given, the ENT identifies the fungi as aspergillosis, and the condition as chronic ethmoidal sinusitis. The specific fungi will not be identified until a culture is taken and sent to pathology for identification. You would use 117.9 while waiting for the specific fungi to be identified, says Barbara J. Cobuzzi, MBA, CPC, CENTC, CPC-H, CPC-P, CPC-I, CHCC, president of CRN Healthcare Solutions, a consulting firm in Tinton Falls, N.J.

When you have this information, then you should proceed by reporting the proper sinusitis code for sinus membrane lining inflammation. In case of chronic sinusitis, you would report 473.x, selecting the fifth-digit code based on where the sinusitis takes place. You would code 461.x for acute sinusitis.

For ethmoidal chronic sinusitis, you should report 473.2 (Chronic sinusitis; ethmoidal). This is a condition that attacks the ethmoid sinuses, which are located within the human skull between the eye sockets and above the nose.

2. Don't Leave Out Underlying Fungal Infection Code

After you've coded the manifestation, you should then report the ICD-9 code that best represents the fungal infection. Some kinds of mycoses include dermatophytosis (110), candidiasis (112), and blastomycotic infection (116). The fungus aspergillus (117.3, Aspergillosis) is found in compost heaps, air vents and airborne dust. Inhaling it may cause ethmoidal sinusitis due to aspergillosis.

On your claim, you should write down 117.3 as diagnosis 1 and 473.2 as diagnosis 2, specifically in Box 21 of the CMS-1500 form.

Quick fact: The condition caused by fungus aspergillus is usually marked by inflammatory granulomatous lesions in the skin, ear, orbit, nasal sinuses, lungs, and sometimes in the bones and meninges.