Pulmonology Coding Alert

Learn how to code patients’ noncompliance of treatment.

The 2023 ICD-10-CM code set has been released, and it includes more than 1,400 new codes. With codes added to provide greater specificity when reporting endometriosis of the cardiothoracic space as well as new Z codes to help explain a patient’s or caregiver’s noncompliance of treatment, the 2023 ICD-10-CM code set contains several changes that apply to you and your pulmonology practice starting Oct. 1, 2022.

Read on to learn about the new or converted ICD-10-CM codes of which pulmonology coders should take note.

Understand How to Code Dyspnea Following a Transfusion

Transfusion-associated dyspnea (TAD) is respiratory distress that occurs within 24 hours of the conclusion of a blood transfusion. “TAD is dyspnea that cannot be attributed to another source or reaction of transfusion, such as volume overload or an allergic reaction,” 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. Physicians apply a TAD diagnosis when there is no other explanation for the dyspnea (shortness of breath) post-transfusion, according to Pohlig.

For fiscal year (FY) 2023, the ICD-10-CM code set adds J95.87 (Transfusion-associated dyspnea (TAD)) and the code features an Excludes1 note that instructs you to not report E87.71 (Transfusion associated circulatory overload) or J95.84 (Transfusion-related acute lung injury (TRALI)) in conjunction with J95.87.

Precisely Code Endometriosis Outside the Pelvic Region

One area of the 2023 ICD-10-CM code set that sees significant additions is the N80.- (Endometriosis) category. “Endometriosis is a bit more complicated than just identifying the impacted site. The extent of infiltration can be superficial or deep, and pain increases as time goes on,” Pohlig says. For this reason, the American College of Obstetricians and Gynecologists (ACOG) and American Association of Gynecologic Laparoscopists (AAGL) requested the Centers for Disease Control and Prevention (CDC) to consider expanding ICD-10-CM codes in this category in 2020. The ACOG and AAGL wrote the code category expansion would “enable better tracking, measurement, and ultimately treatment for endometriosis” (www.cdc.gov/nchs/data/icd/Topic-packet-September-8-9.2020.pdf).

ICD-10-CM subcategory N80.B- (Endometriosis of cardiothoracic space) is a new parent code effective Oct.1, 2022. Under N80.B- are six expanded codes relating to endometriosis of the different body structures in that area.

The six expanded codes include:

• N80.B1 (Endometriosis of pleura)
• N80.B2 (Endometriosis of lung)
• N80.B3- (Endometriosis of diaphragm)
• N80.B4 (Endometriosis of the pericardial space)
• N80.B5 (Endometriosis of the mediastinal space)
• N80.B6 (Endometriosis of cardiothoracic space)

Starting October 1, you’ll have more options for further specifying the endometriosis of the patient’s diaphragm since N80.B3- codes require a 6th character to specify the extent of infiltration. These codes include:

• N80.B31 (Superficial endometriosis of diaphragm)
• N80.B32 (Deep endometriosis of diaphragm)
• N80.B39 (Endometriosis of diaphragm, unspecified depth)

People often equate endometriosis with the pelvic region, but the condition can occur in other body areas. “These new codes will also identify those rare conditions that extend into and beyond the thoracic area. The complexity of this diagnosis code category should signify the complexity of care required to treat this condition,” Pohlig adds.

Explain Noncompliance of Treatment With Added Z Codes

In ICD-10-CM 2023, 36 codes are converted to parent codes. This means certain codes are expanding to provide greater specificity when reporting a patient’s diagnosis.

Of the hundreds of changes in ICD-10-CM 2023, more than 50 codes are added or converted to parents in the Social Determinants of Health (SDoH) category. These codes help you paint the complete clinical picture and can help explain why a patient or caregiver may have trouble adhering to a treatment plan.

For example, you’ll be able to use several codes under the existing Z91.1- (Patient’s noncompliance with medical treatment and regimen) and added Z91.A- (Caregiver’s noncompliance with patient’s medical treatment and regimen) subcategories to report a patient’s or caregiver’s noncompliance of medical treatment and regimen.

This attention to understanding a patient’s SDoH can prove helpful to providers trying to deliver proper care. “Sometimes compliance is out of a patient’s control, especially when they cannot afford out-of-pocket expenses due to lack of insurance or proper coverage. Being able to identify the source of noncompliance (patient or caregiver, affordability, or lack of understanding) could assist the provider in identifying the proper patient resources,” Pohlig says.

Patient noncompliance codes under Z91.19- (Patient’s noncompliance with other medical treatment and regimen) include:

• Z91.190 (Patient’s noncompliance with other medical treatment and regimen due to financial hardship)
• Z91.198 (Patient’s noncompliance with other medical treatment and regimen for other reason)
• Z91.199 (Patient’s noncompliance with other medical treatment and regimen due to unspecified reason)

But if the patient’s caregiver is responsible for patient noncompliance, you’ll assign a code from the Z91.A-subcategory, which includes:

• Z91.A2 (Caregiver’s intentional underdosing of patient’s medication regimen)
• Z91.A20 (Caregiver’s intentional underdosing of patient’s medication regimen due to financial hardship)
• Z91.A28 (Caregiver’s intentional underdosing of medication regimen for other reason)

Note: For the full list of added, revised, and deleted ICD-10 codes for 2023, go to www.cdc.gov/nchs/icd/Comprehensive-Listing-of-ICD-10-CM-Files.htm, click on the ICD-10-CM FY 2023 Addenda PDF link, and download the Addendum zip file.