Pulmonology Coding Alert

This April 1 ICD-10-CM release is effective from April 1, 2024 through Sept. 30, 2024.

“In 2021, CMS/CDC finalized the proposal to expand the April 1 ICD-10-CM update beyond the ‘emergent use’ that allowed only new diagnosis codes for emerging diseases (eg, COVID) and new procedure codes (eg, COVID vaccine),” 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. “This would ensure timely and accurate information for providers to use in addressing patient care,” she added.

Recognize Respiratory Code Note Changes

According to the Centers for Medicare & Medicaid Services (CMS), the 2024 midyear update does not contain any changes to the codes, but “addresses typographical errors.” The code set features several additions, deletions, and revisions that could affect your pulmonology coding.

Several of these changes are evident in the Tabular List. Effective April 1, 2024, the Excludes1 note for J12.- (Viral pneumonia, not elsewhere classified) becomes an Excludes2 note. All the codes listed under the Excludes1 note have migrated to the Excludes2 note.

Code J18.0 (Bronchopneumonia, unspecified organism) sees changes to the Excludes2 note listed under the code. Going forward, you’ll be able to assign J44.89 (Other specified chronic obstructive pulmonary disease) if the patient is also experiencing chronic bronchiolitis. The Excludes2 note instructs you to assign J44.89 for an “other specified chronic obstructive pulmonary disease” diagnosis.

The last change in Chapter 10 affects the Excludes2 note under parent code J45.- (Asthma). You’ll assign J44.89 instead of J44.9 (Chronic obstructive pulmonary disease, unspecified) if the patient is also experiencing any of the following conditions:

• Asthma with chronic obstructive pulmonary disease
• Chronic asthmatic (obstructive) bronchitis
• Chronic obstructive asthma

CMS also adds Other specified chronic obstructive pulmonary disease (J44.89) to the J45.- Excludes2 note like the agency did with J18.0’s Excludes2 note.

Turning to Chapter 16 in the Tabular List, you’ll find a code correction in the P28.5 (Respiratory failure of newborn) Excludes2 note. Starting April 1, the respiratory distress of newborn note no longer has a dash at the end of the code to indicate additional characters are needed to complete the code.

Below is what the note had listed from Oct. 1 until March 31, and how the note is listed as of April 1:

• Oct. 1: respiratory distress of newborn (P22.0-)
• April 1: respiratory distress of newborn (P22.0)

Remember: An Excludes2 note indicates that two or more conditions may exist at the same time, and you may report the conditions together if the physician has documented them.

Analyze These Alphabetic Index Adjustments

The Tabular List isn’t the only ICD-10-CM code set section to have changes on April 1. The Alphabetic Index has a handful of revisions that might affect your coding selections.

As a pulmonology coder, you’ll want to take note of the change under Bronchiolitis (acute) (infective) (subacute). One of the first indentations under the main term is chronic (fibrosing) (obliterative), which directs you to J44.89. On April 1, obliterative is deleted from the indented term.

This is because the next indentation lists obliterative to direct you to J44.81 (Bronchiolitis obliterans and bronchiolitis obliterans syndrome), which includes obliterative bronchiolitis as an additional synonym.

Resource: Review the April 1, 2024 ICD-10-CM release at www.cdc.gov/nchs/icd/Comprehensive-Listing-of-ICD-10- CM-Files.htm.