Otolaryngology Coding Alert

Tip: Beware submitting probable diagnoses.

If you use 748.3 for all your 'other' congenital abnormalities of the trachea and bronchi for conditions not otherwise specified in ICD-9, then you should be prepared to encounter more specific 'other' codes in ICD-10. Most of them focus on the anatomical areas.

Also referred to as congenital deformities of the upper airway, the current ICD-9 code includes:

• laryngomalacia -- a form of congenital laryngeal stridor characterized by flaccidity of the supraglottic structures;
• laryngeal cyst -- a mucus-filled dilatation of the laryngeal saccule which may distort the aryepiglottic fold, the false cord or the laryngeal ventricle;
• laryngocoele -- an air-filled dilatation of the ventricular sinus of Morgagni;
• laryngeal web or glottis;
• Cri-du-chat syndrome;
• vocal cord paralysis;
• subglottic stenosis;
• subglottic haemangioma; and
• laryngotracheal cleft.

Abnormalities of the trachea and bronchi include agenesis, stenosis, tracheomalacia,  vascular compression, vascular ring, bronchial bifurcations, and anterior/posterior compression.

Right now, if a patient suffers from any of the conditions previously enumerated, the ENT would likely diagnose her with "other congenital anomalies of larynx trachea and bronchus" which you would report with 748.3 (Other congenital anomalies of larynx trachea and bronchus).

ICD-10 Change: When ICD-9 transitions to ICD-10 on Oct. 1, 2013, 748.3 will expand into five more specific diagnosis codes:

• Q31.1 -- Congenital subglottic stenosis
• Q31.3 -- Laryngocele
• Q31.8 -- Other congenital malformations of larynx
• Q32.1 -- Other congenital malformations of trachea
• Q32.4 -- Other congenital malformations of bronchus.

This is an example of why coders need to brush up on their anatomy and pathophysiology in preparation for the ICD-10 implementation.

Documentation: Remember, you should code only the confirmed diagnoses. Do not code "suspected," "rule out" or "probable" diagnoses. You may report codes that describe signs and symptoms, as opposed to diagnoses, when the ENT has not established a related definitive diagnosis.

Coder tips: Two of the commonly used CPT codes that an ENT would link to Q31.1, Q31.3, Q31.8, Q32.1, or Q32.4 are 31770 (Bronchoplasty; graft repair) and 31775 (Bronchoplasty; excision stenosis and anastomosis). A bronchoplasty is performed with either graft repair or excision of a stenosis with anastomosis.