Outpatient Facility Coding Alert

Grab the mixed bag of new codes with respiratory system postprocedural hematomas, mediastinitis, and more.

The final 2017 ICD-10-CM codes are already in, and pulmonology is one area with updates you may not want to miss. “Seems like ICD-10 implementation has been going much smoother than expected,” says Sarah Goodman, MBA, CHCAF, CPC-H, CCP, FCS, president of the consulting firm SLG, Inc., in Raleigh, N.C. That said, you still need to be on your toes not to miss out on significant changes. Read on for important revisions, deletions, and new additions that will affect your coding.

Look Out for Revisions in COPD, Bronchiectasis and The Like

Here are some changes to look out for:

• Under J44 (Other chronic obstructive pulmonary disease), delete the Excludes1 note of “lung diseases due to external agents (J60-J70)” and add an Excludes2 notes of “lung diseases due to external agents (J60-J70).”
• For J47.0 (Bronchiectasis with acute lower respiratory infection), add “Use additional code to identify the infection.”
• As for code J84.89 (Other specified interstitial pulmonary diseases), delete “Organizing pneumonia due to known underlying cause” from its extended descriptor.
• Revise J95.83 from “Postprocedural hemorrhage and hematoma of a respiratory system organ or structure following a procedure” to “Postprocedural hemorrhage of a respiratory system organ or structure following a procedure.”
• Revise J95.830 from “Postprocedural hemorrhage and hematoma of a respiratory system organ or structure following a respiratory system procedure” to “Postprocedural hemorrhage of a respiratory system organ or structure following a respiratory system procedure.”
• Revise J95.831 from “Postprocedural hemorrhage and hematoma of a respiratory system organ or structure following other procedure” to “Postprocedural hemorrhage of a respiratory system organ or structure following other procedure.”

Replace “Tobacco Use” With “Tobacco Dependence”

For most of the codes in Chapter 10, Diseases of the Respiratory System (J00-J99), the “use additional” term has been revised from “history of tobacco use” (Z87.891) to “history of tobacco dependence” (Z87.891). This revision encompasses all J codes that listed Z87.891 as an additional term.

Get to Know This Mixed Bag of New Codes

Apart from the number of code revisions, the update also promises pulmonology coders some fresh codes to add to their claims. These include:

• J95.86, Postprocedural hematoma and seroma of a respiratory system organ or structure following a procedure
• J95.860, Postprocedural hematoma of a respiratory system organ or structure following a respiratory system procedure
• J95.861, Postprocedural hematoma of a respiratory system organ or structure following other procedure
• J95.862, Postprocedural seroma of a respiratory system organ or structure following a respiratory system procedure
• J95.863, Postprocedural seroma of a respiratory system organ or structure following other procedure.

Relearn mediastinitis: Mediastinitis codes have undergone a big overhaul with an increased focus on specificity. We have two new diagnosis options to implement in October:

• J98.51 (Mediastinitis) with an addition of the phrase “Code first underlying condition, if applicable, such as postoperative mediastinitis (T81.-)”
• J98.59 (Other diseases of mediastinum, not elsewhere classified) with addition of terms such as 

       o Fibrosis of mediastinum
       o Hernia of mediastinum
       o Retraction of mediastinum

Note: The terms fibrosis/hernia/retraction of mediastinum, mediastinitis have been deleted from the extended description of J98.5 (Diseases of mediastinum, not elsewhere classified).  

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