Pulmonology Coding Alert

Think you mastered the updates? Find out!

Check your work to see if your answers from the quiz questions on page 3 match up with the ones provided below.

Remember TAD Has Only 1 Symptom

Answer 1: For this scenario, you’ll assign J95.87 (Transfusion-associated dyspnea (TAD)) to report the transfusion-associated dyspnea (TAD) diagnosis. The physician documented this diagnosis since the patient recently underwent a blood transfusion and only experienced shortness of breath (SOB) as a result of the procedure.

“TAD is a condition that occurs within 24 hours of a transfusion and the only symptom is respiratory distress,” says Julie Davis, CPC, CRC, COC, CPMA, CPCO, CDEO, Approved Instructor, risk adjustment manager of Physician Health Partners in Parker, Colorado. Since respiratory distress is the lone associated symptom of TAD, the diagnosis cannot be with other conditions that can occur following a transfusion, such as transfusion-related acute lung injury (TRALI), transfusion-associated circulatory overload (TACO), and an allergic reaction.

Navigate Newborn Sleep Apnea Code Options

Answer 2: You’ll assign P28.32 (Primary obstructive sleep apnea of newborn) to report the newborn’s primary obstructive sleep apnea diagnosis. Obstructive sleep apnea occurs when the patient’s breathing stops due to an obstruction in the airway. Obstructions can be the patient’s tongue or the muscles collapsing on the airway.

You can use several codes new to the 2023 ICD-10-CM code to identify primary sleep apneas of a newborn. These codes fall under the P28.3- (Primary sleep apnea of newborn) code subcategory. In this subcategory, a 5th character is required to specify the type of sleep apnea. For this scenario, the 5th character “2” indicates obstructive sleep apnea.

Prior to Oct. 1, 2022, you could select only P28.3 in the ICD-10-CM code set to report all forms of sleep apnea. The new codes for the 2023 code set allow you to distinguish between the different causes of newborn and infant sleep apnea, which is beneficial for providers when creating a treatment plan.

“Each of these causes may be treated in a specific manner, but home monitoring is a common tool utilized in care of the infant. Having a more specific diagnosis linked to the patient’s medical record may positively impact the care that they receive,” says Carol Pohlig, BSN, RN, CPC, manager of coding and education in the department of medicine at the Hospital of the University of Pennsylvania in Philadelphia. If the patient’s home monitoring device suggests a problem with the patient, then parents will be seeking acute care for their infant. In those cases, the clinicians can implement an appropriate treatment in a timely manner if they know what type of sleep apnea is involved, Pohlig adds.

Stay mindful of the guidelines: If you are reading the provider’s documentation and are unsure which obstructive sleep apnea to assign between P28.32 and G47.33 (Obstructive sleep apnea (adult) (pediatric)), a review of the ICD-10-CM Official Guidelines, Section I.C.16, which applies to P codes, will help. The guidelines instruct that any condition occurring “before birth through the 28th day following birth” falls under the perinatal period. Since the patient in the scenario is only five days old, assigning P28.32 is the correct OSA code.

Explore the Expanded Endometriosis Code Category

Answer 3: Yes, you can assign N80.B2 (Endometriosis of lung) to report the physician’s diagnosis of endometriosis of the left lung. The N80.- (Endometriosis) code category was expanded in the 2023 ICD-10-CM code set to allow greater specificity regarding the infiltration of the condition.

Endometriosis is a painful condition, where the endometrium (tissue lining the inside of the uterus) grows outside the uterus. The condition commonly affects reproductive body structures, such as the fallopian tubes, ovaries, and tissue lining the pelvis, but endometriosis is a condition that can be more complicated than affecting a specific site.

Previous ICD-10-CM codes for endometriosis didn’t “provide details in terms of laterality, location, depth of invasion, volume of disease, or what organ is involved. So, the addition of these new code areas, specifically location, will have direct implication on the disease management,” said Jill Young, CEMC, CPC, CEDC, CIMC, of Young Medical Consulting LLC in East Lansing, Michigan during AAPC’s “ICD-10-CM Updates for 2023” webinar.

The American College of Obstetricians and Gynecologists (ACOG) and American Association of Gynecologic Laparoscopists (AAGL) requested that the Centers for Disease Control and Prevention (CDC) expand the N80.- code category at a 2020 ICD-10 Coordination and Maintenance Committee Meeting (www.cdc.gov/nchs/data/icd/Topic-packet-September-8-9.2020.pdf). “ACOG and AAGL request the N80.- code category to be expanded to provide additional specificity for appropriate diagnosis coding and to assist in measuring the incidence of these specific conditions.”

The new codes for the 2023 ICD-10-CM code set, including N80.B2, identify the rare conditions where endometriosis extends into and beyond the thoracic area. “The complexity of this category of diagnosis code should signify the complexity of care required to treat this condition,” Pohlig adds.