Pulmonology Coding Alert

From cystic fibrosis to TB, find out how to code these diagnoses.

Pediatric patients often present to pulmonologists with complex respiratory conditions, sometimes requiring a variety of diagnosis codes to report. If you’ve ever struggled with coding these charts, you know how important it is to scour the notes for clues that can lead you to the correct ICD-10 code.

Check out the following three pediatric lung conditions and get a handle on exactly how to code them.

Check “E” Codes for Cystic Fibrosis

Cystic fibrosis is a genetic condition that causes progressive damage to the lungs, and is typically diagnosed within the first month after a child is born. When your pulmonologist confirms a CF diagnosis, you should look toward the ICD-10 code range E84.0-E84.9.

Suppose the pulmonologist sees a CF patient showing pulmonary exacerbation. She will order a direct sputum acid-fast stain and culture for identifying the mycobacteria. In this situation, although the code E84.9 (Cystic fibrosis, unspecified) covers the general condition, you should consider going deeper into the family of codes to find a specific code.

In this case, you can use E84.0 (Cystic fibrosis with pulmonary manifestations) since the physician clearly stated “pulmonary exacerbation” in the narrative description. Once the organism has been identified, then an additional code to represent the organism can be reported for any further services.

For Bronchopulmonary Dysplasia, Look to “P” Codes

Mainly impacting premature infants, bronchopulmonary dysplasia typically happens via damage that respirators cause when newborns are in the neonatal intensive care unit. Although the condition is usually short-term, some children have long-term damage from the condition that pulmonologists have to treat for extended time periods.

To report this condition, you’ll submit code P27.1 (Bronchopulmonary dysplasia originating in the perinatal period). Because this is the only code in ICD-10 that reflects this condition, there is no need to extend the diagnosis out to additional characters.

If, however, the patient no longer has the condition and the pulmonologist sees the same patient for another condition – such as asthma – afterward, do not code the P27.1, even as a secondary diagnosis.

Tuberculosis Points to “A” Code Range

Although many coders are surprised when a TB patient presents to the practice, the reality is that tuberculosis has never been eradicated in the US, and patients still do present to the pulmonologist for treatment of this condition.

This condition can strike not only the lung, but also other respiratory organs such as the larynx, trachea, bronchus, or lymph nodes. To code this condition, you’ll look at the A15.0-A19.9 range in the ICD-10 handbook, carefully seeking the anatomic area affected in your patient.

For example, if a patient resents with tuberculosis affecting the lung, you’ll report A15.0 (Tuberculosis of lung). No additional characters are needed.