Pulmonology Coding Alert

Pay attention to parent code notes.

Several conditions in the ICD-10-CM code set are classified as acute or chronic. Pulmonary edema is one such ailment, and knowing how to code the illness as well as associated risk factors can help boost your practice’s bottom line.

Read on to learn the differences between acute and chronic pulmonary edema.

Break Down the Condition

Pulmonary edema is a condition where excess fluid builds up in the alveolar sacs of the patient’s lungs. The buildup causes shortness of breath and low oxygen levels in the blood, as the alveolar sacs facilitate the exchange of oxygen and carbon dioxide during the breathing process.

The condition may originate from cardiogenic conditions, such as heart valve issues, cardiomyopathy, or coronary artery disease (CAD), or non-cardiogenic conditions like high altitudes, pulmonary embolism, adverse drug reaction, or viral infection.

Pulmonary edema can develop suddenly (acute) or over time (chronic). Acute pulmonary edema is a medical emergency that requires immediate attention. The patient may experience severe shortness of breath that gets worse when lying down or performing an activity, a cough that produces blood, and a rapid, irregular heartbeat, among other symptoms.

Patients experiencing chronic pulmonary edema may have symptoms of breathing difficulties when lying flat or during activities, a breathless feeling that is relieved by sitting up, fatigue, and more.

Identify the Correct ICD-10-CM Codes

The ICD-10-CM code set lists two codes under J81.- (Pulmonary edema) that represent acute or chronic pulmonary edema:

• J81.0 (Acute pulmonary edema)
• J81.1 (Chronic pulmonary edema)

Each code features additional synonyms that you should refer to if the pulmonologist documents the patient’s diagnosis slightly differently. Code J81.0 features the synonym “Acute edema of lung,” whereas J81.1 features “Pulmonary congestion (chronic) (passive)” and “Pulmonary edema NOS.”

To locate the ICD-10-CM codes, you’ll open the Alphabetic Index and look for Edema, edematous (infectious) (pitting) (toxic). Follow the indentations to pulmonary, where you’re redirected to look up Edema, lung. Indentations under Edema, lung include acute and chronic. You’ll then verify the codes in the Tabular List.

Important: The parent code J81.- features Excludes1 and Use additional code notes that provide useful instructions when coding pulmonary edema conditions. The Excludes1 note lists several conditions that cannot be coded with J81.0 or J81.1. These conditions include:

• J68.1 (Pulmonary edema due to chemicals, gases, fumes and vapors)
• J18.2 (Hypostatic pneumonia, unspecified organism)
• J60-70 (Lung diseases due to external agents)
• I50.1 (Left ventricular failure, unspecified)

The J81.- Excludes1 note features different terms from the official descriptors, such as “chemical (acute) pulmonary edema” for J68.1, “passive pneumonia” or “hypostatic pneumonia” for J18.2, and “pulmonary edema with heart disease NOS” and “pulmonary edema with heart failure” for I50.1.

If the patient has a history of, exposure to, or dependence on tobacco, you’ll also need to assign the code that represents the patient’s relationship with the drug. The Use additional code to identify note instructs you to select from the following:

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

Examine This Pulmonary Edema Scenario

Scenario: A patient presents with complaints of coughing up blood, wheezing, shortness of breath, and difficulty speaking in full sentences. During the history, the patient stated they currently smoke one pack of cigarettes per day. The provider orders a chest X-ray and echocardiogram to evaluate the patient. After interpreting the results of the exams, the pulmonologist diagnoses the patient with acute edema of the lungs.