Pulmonology Coding Alert

Did you pick out the correct RAS codes?

How well did you pay attention to the J-code changes in the ICD-10-CM code set this year? See if your answers from the quiz questions on page 3 match up with the ones provided below.

Analyze This Acinetobacter baumannii Pneumonia Case

Answer 1: You’ll assign J15.61 (Pneumonia due to Acinetobacter baumannii) to report the patient’s diagnosis.

Code J15.6- (Pneumonia due to other Gram-negative bacteria) was converted into a parent code on Oct. 1, 2023. The code family features two codes, J15.61 and J15.69 (Pneumonia due to other Gram-negative bacteria), which you’ll select from based on which gram-negative bacteria is causing the pneumonia.

In the Alphabetic Index, search for Pneumonia > in (due to) > Acinetobacter baumannii. You’ll then verify the code in the Tabular List.

Pneumonia is a lung infection, which is commonly caused by bacteria or viruses. In this scenario, the patient’s pneumonia

is caused by an Acinetobacter baumanii bacterial infection. Common bacterial pneumonia symptoms include:

• High fever
• Cough with yellow, green, or blood-tinged sputum
• Headache
• Chills
• Lethargy
• Breathlessness

According to the Centers for Disease Control and Prevention (CDC), Acinetobacter baumannii makes up most Acinetobacter infections in humans. The bacteria is commonly found in the environment, such as the water and soil. An infection can manifest with the following symptoms:

• Fever
• Chills
• Cough
• Recognize RAS Coding Rules

Answer 2: You’ll assign J4A.0 (Restrictive allograft syndrome) and T86.818 (Other complications of lung transplant) to report the pulmonologist’s diagnoses.

Restrictive allograft syndrome (RAS) is a form of chronic lung allograft dysfunction (CLAD) that occurs following a lung transplant procedure. The lung fails to function properly, which can result in the patient experiencing restricted breathing and peripheral lung fibrosis.

In the Alphabetic Index, look for Syndrome > restrictive allograft, which will direct you to J4A.0. You’ll then verify the code in the Tabular List.

Parent code, J4A.- (Chronic lung allograft dysfunction), features a Code first note, which instructs you to assign one of the following codes if the condition is documented in the medical record:

• T86.31 (Heart-lung transplant rejection)
• T86.810 (Lung transplant rejection)
• T86.39 (Other complications of heart-lung transplant)
• T86.818

You’ll report T86.818 as the second diagnosis code to show that the patient’s recent lung transplant is what is causing the patient’s restrictive allograft syndrome.

Boost Your Bronchitis and Bronchiectasis Coding Knowledge

Answer 3: In this scenario, you’ll need two ICD-10-CM codes to report the diagnoses. You’ll assign J44.89 (Other specified chronic obstructive pulmonary disease) to report the chronic asthmatic bronchitis diagnosis. While J44.89’s descriptor is listed as “Other specified chronic obstructive pulmonary disease,” two diagnoses are included in the code:

• Chronic asthmatic (obstructive) bronchitis
• Chronic emphysematous bronchitis

Next, you’ll assign J47.1 (Bronchiectasis with (acute) exacerbation) to report the bronchiectasis with acute exacerbation diagnosis.

Tobacco dependence: Parent code J47.- (Bronchiectasis) features a Use additional code note, instructing you to use any of the following codes to identify the patient’s use of, dependence on, or exposure to tobacco:

• Z77.22 (Contact with and (suspected) exposure to environmental tobacco smoke (acute) (chronic))
• P96.81 (Exposure to (parental) (environmental) tobacco smoke in the perinatal period)
• Z87.891 (Personal history of nicotine dependence)
• Z57.31 (Occupational exposure to environmental tobacco smoke)
• F17.- (Nicotine dependence)
• Z72.0 (Tobacco use)

Take extra care to double check the provider’s documentation to ensure you’re assigning all applicable codes to show medical necessity for procedures and paint the full picture of the patient’s condition.