Primary Care Coding Alert

See how well you can navigate these diagnosis codes.

Once you’ve answered the quiz questions on page 3 compare your answers with the ones provided below.

Answer 1: RSV is seen most often in young people, but it’s not exclusively a pediatric condition. The patient’s age is a factor in where an RSV infection sets in. “The lungs or large bronchi are usually the sites of infections in adults. Young children are more commonly infected in the smaller bronchial tubes called bronchioles,” says Sheri Poe Bernard, CPC, CRC, CDEO, CCS-P, of Granite GRC Consulting in Salt Lake City, Utah.

“Recovery from RSV is complicated for the very old, the very young, and those with respiratory, cardiac, or immune disorders,” says Bernard.

In U.S. children younger than 1 year old, RSV is the most common cause of bronchiolitis (small airway inflammation). According to the Centers for Disease Control and Prevention (CDC), RSV infections result in:

• Approximately 177,000 hospitalizations for people older than 65 years old
• Approximately 58,000 hospitalizations for children under 5 years old
• Approximately 14,000 deaths for older people and up to 300 deaths of young children

(Source: www.cdc.gov/rsv/research/us-surveillance.html)

Answer 2: RSV infections commonly cause other infections. When one infection leads to another, coding of the diagnoses can become complicated. “For bronchitis, bronchiolitis, and pneumonia, the ICD classifies a single code to capture each site and infectious agent for RSV,” Bernard adds.

Bronchitis: You’ll select J20.5 (Acute bronchitis due to respiratory syncytial virus) if the physician documented that the RSV infection is causing an acute case of bronchitis with the patient. Bronchitis occurs when the main airways in the lungs, known as bronchial tubes, become inflamed and cause the patient to cough. Often the bronchial tubes will fill with mucus, which loosens during a coughing bout.

Bronchiolitis: Common in infants and young children, bronchiolitis is inflammation and congestion of the bronchioles (small airways) of the patient’s lungs. A viral infection is the most common cause of bronchiolitis. You’ll assign J21.0 (Acute bronchiolitis due to respiratory syncytial virus) when a physician diagnoses a patient with acute bronchiolitis caused by an RSV infection.

Pneumonia: You’ll assign J12.1 (Respiratory syncytial virus pneumonia) if you have a medical report where the physician has documented that the patient is experiencing pneumonia from RSV. One of the most common viral causes of pneumonia in the U.S. is RSV. Pneumonia is an infection in the lungs, and it is commonly caused by viruses or bacteria.

Answer 3: It’s true that a single code may not be enough to code the diagnosis if RSV caused another illness. In the ICD-10-CM code set Alphabetic Index, look for Virus, viral > respiratory syncytial (RSV), where you’ll find several conditions related to RSV.

“For generalized respiratory infections, otitis media, or other infection sites, coders are instructed to report two codes: one for the site of infection, and a second code, B97.4 (Respiratory syncytial virus as the cause of diseases classified elsewhere),” Bernard says.

If the physician has documented that the RSV is causing another disease, you’ll start by verifying B97.4 in the Tabular List. Under B97.4, you’ll find a Code first note that instructs you to report conditions related to the RSV, such as a middle ear infection (H65.-, Nonsuppurative otitis media) or an upper respiratory disease (J06.9, Acute upper respiratory infection, unspecified), before reporting B97.4.

Answer 4: No, you won’t always need to report a testing code. Mild RSV symptoms are similar to symptoms of the common cold, which means if the provider suspects an RSV infection because of the patient’s medical history, a physical examination, and the number of cases in the area, the provider may order lab tests to confirm the RSV diagnosis.

A physician may capture a mouth or nasopharyngeal (through the nose to the throat) swab to test for an RSV infection. You’ll assign 87807 (Infectious agent antigen detection by immunoassay with direct optical (ie, visual) observation; respiratory syncytial virus) to report a rapid RSV antigen test.

A provider also may order a blood test to check for an RSV infection. The CPT® code set includes several codes related to a blood test for RSV, such as:

87631 (Infectious agent detection by nucleic acid (DNA or RNA); respiratory virus (eg, adenovirus, influenza virus, coronavirus, metapneumovirus, parainfluenza virus, respiratory syncytial virus, rhinovirus), includes multiplex reverse transcription, when performed, and multiplex amplified probe technique, multiple types or subtypes, 3-5 targets)

• 87632 (… 6-11 targets)
• 87633 (… 12-25 targets)

“Choose the code according to the number of infectious agents being screened,” Bernard says. While 87631-87633 are all used to screen for infectious respiratory viruses, the codes differ in the number of viruses being tested for.

Answer 5: Currently, there are no vaccines to protect from RSV and therefore there are no vaccine product or administration codes. However, vaccine research studies are underway, and some companies are planning regulatory submissions in the near future.

See page 3 to go back to the quiz.