Pulmonology Coding Alert

You’ll find hundreds of changes in the 2020 diagnosis code set.

When it comes to treating pulmonary embolism, you may see a vast range of specific conditions — some of which aren’t easy to find in the ICD-10 manual. Fortunately, CMS is expanding your options effective Oct. 1, thanks to almost 400 changes and updates to the ICD-10-CM code list. The agency published the full listing of codes in mid-June, but we’ve reviewed the list to identify the changes most relevant to pulmonology practices.

Adopt New Pulmonary Embolism Codes

Effective Oct. 1, you’ll have access to scores of new codes that allow additional specificity in pulmonary embolism coding. The codes open up the options when seeing patients who have blood clots in their lungs. The additions fall in the I26.9 category (Pulmonary embolism without acute cor pulmonale), as follows:

• I26.93 (Single subsegmental pulmonary embolism without acute cor pulmonale)
• I26.94 (Multiple subsegmental pulmonary emboli without acute cor pulmonale)

Here’s what that means: “Cor pulmonale” refers to an abnormal enlargement of the right side of the heart due to a disease of the pulmonary blood vessels or the lungs.

The presence or absence of this added complication virtually decides the direction your coding goes in selecting the final code. For example, a case of simple septic pulmonary embolism will now map to I26.93. If the physician can confirm the underlying infection, you would report this code as well. These new codes allow you to specify whether the patient has multiple emboli or just one in the absence of cor pulmonale.

“The change is a result of a proposal put forward by the American College of Chest Physicians [ACCP], who pointed out that, as the optimal treatment for these conditions is different from other pulmonary emboli, and as these kind of emboli could only previously be coded to an ‘other’ code — I26.99 (Other pulmonary embolism without acute cor pulmonale) — the conditions needed their own separate codes,” says Melanie Witt, RN, CPC, MA, an independent coding expert based in Guadalupita, New Mexico.

Coder tip: If the pulmonary specialist can’t identify the type of pulmonary embolism, you have an easy way out. Pulmonary embolism not otherwise specified (NOS) will be classified to I26.99.

Expand Your DVT Code Know-How

Coding for deep vein thrombosis (DVT) will get a lot more detailed under ICD-10 starting in October. Here’s what you can expect.

Diagnosis: Embolism is the obstruction of a vessel by a clot or foreign substance (such as plaque or fatty deposits). Thrombosis is obstruction by a blood clot. The codes featured here are specific to deep vessels, and that means the codes are appropriate for DVT, whether the patient’s particular condition is considered acute or chronic.

Under the I82.4 (Acute embolism and thrombosis of deep veins of lower extremity) and I82.5 (Chronic embolism and thrombosis of deep veins of lower extremity) categories, ICD-10 will expand to debut four new sections:

• I82.45x (Acute embolism and thrombosis of peroneal vein): This code set ranges from I82.451 (… right peroneal vein) to I82.459 (… unspecified peroneal vein). These codes are site and laterality specific.
• I82.46x (Acute embolism and thrombosis of calf muscular vein): This range also includes additional codes ranging from I82.461 (… right calf muscular vein) to I82.469 (… unspecified calf muscular vein), each of which is site-specific to the side of the body affected.
• I82.55 (Chronic embolism and thrombosis of peroneal vein), which includes additional codes from I82.551 (… right peroneal vein) to I82.559 (… unspecified peroneal vein), all describing laterality.
• I82.56 (Chronic embolism and thrombosis of calf muscular vein), which also expands out to additional codes that specify laterality as above.

“Until now, coders could only report such conditions with other and unspecified codes, which could specify laterality, but not specify location as distal calf or proximal thigh,” says Sheri Poe Bernard, CPC, CRC, CDEO, CCS-P, author of the AMA book, Risk Adjustment Documentation and Coding.

These codes better allow you to report DVT of the peroneal or calf muscular veins, but you must select the appropriate code depending on whether the condition is acute or chronic. Your clinician’s documentation will need to be clear about the vessel(s) and limb(s) involved for you to choose the most appropriate ICD-10 code.

Get Comfortable with New TB History Code

If a patient has suffered from tuberculosis, that’s important for a pulmonologist to know when making clinical decisions, since TB can cause damage to the lung tissue. Currently, you can reach for Z86.11 (Personal history of tuberculosis) in these cases, but that code isn’t specific enough to describe patients who have a personal history of latent TB.

Here’s the difference: “Latent tuberculosis infection (LTBI) occurs when a person is infected with the bacteria Mycobacterium tuberculosis, but does not have active tuberculosis (TB) disease,” according to the September 2018 ICD-10-CM Coordination and Maintenance Committee meeting when the National Tuberculosis Controllers Association initially requested a code for the condition. “The only sign of a tuberculosis infection is a positive reaction to the tuberculin skin test or tuberculosis blood test. Compared to active tuberculosis disease, persons with latent tuberculosis infection are not infectious, cannot spread tuberculosis infection to others and normally do not develop TB disease. But persons who have a weak immune system, the bacteria can become active, multiply and cause tuberculosis disease.”

Therefore, the following new code will be effective Oct. 1 to represent the history of the condition:

• Z86.15 (Personal history of latent tuberculosis infection)

Don’t miss: Lastly, there is a small but very significant change to the notes for the Z68 (Body mass index [BMI]) codes. ICD-10 has now changed the age parameters for both the pediatric and adult BMI codes, with the cutoff for the pediatric codes being lowered from 20 years of age to 19, and the cutoff for the adult codes being lowered from 21 years to 20.

Resource: To check out the complete list of new ICD-10 codes, visit the CMS website at  www.cms.gov/Medicare/Coding/ICD10/2020-ICD-10-CM.html.