Pulmonology Coding Alert

Don't report 488.12 unless physician confirms H1N1 influenza. Find out what code should fit your claim.

If you're daunted by the thought of sorting through all the diagnostic coding changes that went into effect on Oct. 1, 2011, worry no more. Get the insider's information with this rundown on some of the new respiratory system diagnosis codes that affect you.

Quick reference: You must always check both the diagnoses index and tabular list for selection of the appropriate codes to include on your encounter form. Check out the first volume of the addenda index (the official ICD-9-CM annual code revisions) is available on the National Center for Health Statistics (NCHS) Web site at www.cdc.gov/nchs/data/icd9/ICD-9-CMINDEXADDENDAfy12.pdf. You can find the volume II (tabular list of diseases addenda) at www.cdc.gov/nchs/data/icd9/ICD-9-CM%20TABULARADDENDAfy12.pdf.

Keep Up With Fresh Novel Influenza Code Amendments

With this condition continually developing new forms, ICD-9-CM has made changes to novel influenza codes for three years in a row. Changes to the novel influenza codes were recommended by the CDC National Center for Immunization and Respiratory Diseases (NCIR), according to the article "ICD-9 Respiratory System Changes for Oct. 1" on the Advance for Health Information Professionals (AHIP) website (http://health-information.advanceweb.com/Web-Extras/CCS-Prep/ICD-9-Respiratory-System-Changes-for-Oct-1.aspx).  

A new subcategory 488.8 (Influenza due to novel influenza A) and associated codes have been created to report Novel influenza A. They are:

• 488.81 -- Influenza due to identified novel influenza A virus with pneumonia
• 488.82 -- Influenza due to identified novel influenza A virus with other respiratory manifestations
• 488.89 -- Influenza due to identified novel influenza A virus with other manifestations.

Definition: Novel influenza includes all human infections with influenza A viruses that are new or different from currently circulating human influenza viruses, as stated in the AHIP article. These include viruses subtyped as nonhuman in origin, and those that cannot be subtyped with standard laboratory methods.

Providers regularly refer to the 2009 pandemic influenza as 2009 H1N1 influenza rather than novel H1N1 influenza, so ICD-9-CM has revised the following codes, with previous references to "novel" in their descriptors to change to "2009." The codes include:

• 488.11 -- Influenza due to identified 2009 H1N1 influenza virus with pneumonia
• 488.12 -- Influenza due to identified 2009 H1N1 influenza virus with other respiratory manifestations
• 488.19 -- Influenza due to identified 2009 H1N1 influenza virus with other manifestations.

Example: A 10-year-old male presented to the office with flu-like symptoms of cough, fever and chills that had worsened over the last few days. The symptoms also included severe chest congestion. The pulmonologist ruled out H1N1 influenza with pneumonia, and treated the patient with Tamiflu. The physician's note documented "probable H1N1 flu." Should you code it with 488.12?

Code it: Don't code 488.12 (Influenza due to identified 2009 H1N1 influenza virus with other respiratory manifestations) because the physician did not confirm that the patient had H1N1 influenza. Don't dare bill category 488 codes when the physician indicates that the infection is suspected, probable, questionable, etc. In hospital inpatient setting, this is an exception to the guideline to assign a code documented as suspected or possible as if it were established. Instead, you should report the condition with 487.1 (Influenza with other respiratory manifestations).

Shift To 512.2 When Reporting Postoperative Air Leaks

ICD-9-CM has implemented revisions and new codes made to Category 512 to differentiate air leaks from pneumothorax. This category is now labeled pneumothorax and air leaks.

New code: You can now report postoperative air leaks using 512.2 (Postoperative air leak). You previously reported this condition with code 512.1 (Iatrogenic pneumothorax), which was misleading because a patient can have a postoperative air leak without significant air in the pleural space causing pneumothorax. ICD-9-CM prohibits reporting 512.1 or 512.2 unless the physician documentation specifically indicates postoperative or due to a procedure.

However, "Patients may also have a persistent air leak that is not postoperative, such as when a chest tube has been placed for a spontaneous pneumothorax and the lung re-expands but the air leak persists. Spontaneous pneumothorax may be primary, or secondary and related to various other conditions such as cystic fibrosis, spontaneous rupture of the esophagus, lung cancer, etc," states the AHIP article.

Meanwhile, 512.8 (Other spontaneous pneumothorax and air leak) now extends to four new codes describing other spontaneous pneumothorax and air leak. These are:

• 512.81 -- Primary spontaneous pneumothorax
• 512.82 -- Secondary spontaneous pneumothorax
• 512.83 -- Chronic pneumothorax
• 512.89 -- Other pneumothorax.

Warning: Don't forget to code the cause first when reporting 512.82. Code 512.89 to report chronic pneumothorax, pneumothorax and spontaneous pneumothorax not otherwise specified.

Three New Codes Complete The 518.5 Category

Mark 518.5 (Pulmonary insufficiency following trauma and surgery) and its three new codes, as follows:

• 518.51 -- Acute respiratory failure following trauma and surgery
• 518.52 -- Other pulmonary insufficiency, not elsewhere classified, following trauma and surgery
• 518.53 -- Acute and chronic respiratory failure following trauma and surgery.

You would use these codes to distinguish postoperative acute respiratory failure from less severe respiratory complications of surgery or trauma.