Pediatric Coding Alert

Question: I’m constantly coding respiratory system conditions incorrectly, and I can’t understand why. The code descriptors are straight­forward, and I’m always reporting the codes that correspond with the symptoms and diagnoses that are in the documen­tation. What am I doing wrong?

Florida Subscriber

Answer: Without knowing specifics, we can only speculate you’re overlooking the note at the beginning of ICD-10 Chapter 10 telling you that “when a respiratory condition is described as occurring in more than one site and is not specifically indexed, it should be classified to the lower anatomic site.” It’s not always understood among coders that this note applies to every code in the section.

All the codes from J00 (Acute nasopharyngitis [common cold]) to J99 (Respirator disorders in diseases classified elsewhere) require a little bit of anatomy knowledge. Helpfully, there are diagrams and descriptions at the top of the chapter for reference. If your pediatrician documents nasopharyngitis and chronic pharyngitis, you wouldn’t code both conditions. Rather, you’d only code J31.2 (Chronic pharyngitis) because the pharynx is anatomically lower in the respiratory system than the nasal passages.

Also, keep in mind that this code section also asks you pay attention to the Use additional code instruction, which tells you to use codes such as Z77.22 (Contact with and (suspected) exposure to environmental tobacco smoke (acute) (chronic)), F17.- (Nicotine dependence), or Z72.0 (Tobacco use) for any associated tobacco exposure, dependence, or use.