Pulmonology Coding Alert

Think you really know your postprocedural complications and disorders of respiratory system codes? See if your answers from the quiz questions on page 3 match up with the ones provided below.

Find the Respiratory Failure and Cancelled Procedure Codes

Answer 1: You’ll assign codes J95.821 (Acute postprocedural respiratory failure) and Z53.09 (Procedure and treatment not carried out because of other contraindication) to report the patient’s diagnosis and that the scheduled bronchoscopy was not completed.

The physician diagnosed the patient with acute postprocedural respiratory failure as a complication of the bronchoscopy. In the ICD-10-CM Alphabetic Index, look for Failure > respiratory > postprocedural (acute), which provides you with J95.821. You’ll then verify the code in the Tabular List.

Since the provider halted the bronchoscopy due to the patient developing complications during the procedure, you’ll need to show that in your coding. “An ICD-10-CM code should be used to represent the patient’s current condition prompting the cessation of the procedure,” 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.

In this case, J95.821 provides an explanation as to why the procedure was stopped. At the same time, you’ll use Z53.09 as the secondary diagnosis code. Why? “Using the Z code as the primary diagnosis listed on the claim may not be appropriate, but its presence as the secondary diagnosis code support the circumstance of an incomplete procedure, and the potential need to repeat the procedure in the future, if possible,” Pohlig adds.

With this information in mind, you’ll sequence the codes as J95.821 as the primary diagnosis code and then Z53.09 as the secondary diagnosis code, unless the payer specifically requires a different sequence.

Bonus: You’ll also need to indicate that the procedure was abandoned due to complications. In this case you’ll append modifier 53 (Discontinued procedure) to the appropriate bronchoscopy code. “Modifier 53 would need to be added to the procedure that was discontinued to identify that the procedure was discontinued,” says Julie Davis, CPC, CRC, COC, CPMA, CPCO, CDEO, CEMC, AAPC Approved Instructor, senior manager of compliance, Honest Medical Group in Parker, Colorado.

Review the Medical Record to Correctly Code VAP

Answer 2: The provider diagnosed the patient with ventilator-associated pneumonia (VAP) due to the mechanical ventilation. You’ll look to the J95.85- (Complication of respirator (ventilator)) code category to find the correct diagnosis code.

Under the J95.85- code category, you’ll find three codes:

• J95.850 (Mechanical complication of respirator)
• J95.851 (Ventilator associated pneumonia)
• J95.859 (Other complication of respirator (ventilator))

Code J95.851 is the correct code choice. Some coders may be tempted to assign J95.850 since the patient’s condition was a complication caused by mechanical ventilator use. However, the provider specifically noted the patient’s pneumonia developed because of ventilator use. This is a case where reviewing the provider’s documentation carefully is crucial to ensuring correct code assignment.

“The biggest mistake that I have seen is that coders sometimes make a leap without the documentation making the connection directly. If the documentation doesn’t clearly make the connection, there needs to be a query done. Only the physician can tell us information,” Davis adds.

Important: Code J95.851 features a Use additional code note that instructs you to report another code to identify the organism causing the pneumonia, if applicable. For example, you’d report codes from the following categories if the provider determined the infections contributed to the VAP:

• B95.- (Streptococcus, Staphylococcus, and Enterococcus as the cause of diseases classified elsewhere)
• B96.- (Other bacterial agents as the cause of diseases classified elsewhere)
• B97.- (Viral agents as the cause of diseases classified elsewhere)

Track Down the TAD Diagnosis Code

Answer 3: Of all the J95.8- coding cases, this one is probably the most straightforward. You’ll assign J95.87 (Transfusion-associated dyspnea (TAD)) to report a transfusion-associated dyspnea (TAD) diagnosis.

TAD is a form of respiratory distress that occurs within 24 hours following the end of a blood transfusion. “The dyspnea cannot be attributed to another source/reaction of transfusion, such as volume overload or an allergic reaction,” Pohlig adds. This is the only diagnosis that is made when there is no other explanation for a patient’s dyspnea following a blood transfusion.

“The only way I would code J95.87 is if the provider documented TAD. I would never make a leap to that diagnosis,” Davis says.

Excludes note: To help prevent coding confusion, the ICD-10-CM code set features an Excludes1 note under J95.87. This Excludes1 note instructs you to not code other conditions, such as E87.71 (Transfusion associated circulatory overload) and J95.84 (Transfusion-related acute lung injury (TRALI)), along with TAD. Each of these conditions are separate and exclusive of each other.

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