Pulmonology Coding Alert

Hint: TAD has only one symptom.

Dyspnea, also known as difficulty breathing or shortness of breath (SOB), is a respiratory symptom that’s common to several pulmonology diagnoses. Starting Oct. 1, 2022, dyspnea is a crucial factor for physicians diagnosing a patient’s adverse reaction to a blood transfusion.

Get to know the differences between TACO, TRALI, and TAD and which codes to assign for each condition.

What Is TAD?

Transfusion-associated dyspnea (TAD) is a condition where the patient experiences respiratory distress within 24 hours of a blood transfusion. “The literature suggests that TAD may be a serious transfusion-related pulmonary complication and needs population-based national monitoring, including understanding the potential risk factors in the elderly and other populations,” said Jill Young, CEMC, CPC, CEDC, CIMC, of Young Medical Consulting LLC in East Lansing, Michigan during AAPC’s “ICD-10-CM Updates for 2023” webinar.

If the dyspnea can be attributed to another source, then the provider will list a different diagnosis. Conditions other than TAD that can occur following a transfusion include an allergic reaction, transfusion-related acute lung injury (TRALI), and transfusion-associated circulatory overload (TACO). TRALI and TACO have symptoms in addition to respiratory distress, which allows the provider to suspect the different diagnoses.

“What’s important to note of TAD is the respiratory distress should be the main condition and shouldn’t be the result of the patient’s underlying condition or another known cause,” says Julie Davis, CPC, CRC, COC, CPMA, CPCO, CDEO, Approved Instructor, risk adjustment manager of Physician Health Partners in Parker, Colorado.

TRALI: This rare, but serious, reaction occurs when the patient’s lungs experience fluid buildup.

However, the buildup isn’t related to the blood products transfused or an excessive volume of blood. The provider may suspect the patient is experiencing TRALI if the patient is exhibiting acute respiratory distress along with any of the following symptoms within six hours of the transfusion:

• Fever with or without chills
• Hypotension (low blood pressure)
• Unresponsive to diuretics

TACO: With TACO, the patient may not be able to effectively process the transfused volume of blood or blood components. The condition can happen due to an underlying kidney or heart condition or because of an overly high infusion rate or volume. The physician could suspect TACO if the patient is experiencing respiratory distress and the following symptoms:

• Fever with or without chills
• Hypertension (high blood pressure)
• Responsive to diuretics
• Cough
• Fluid overload

Allergic reaction: If the transfused blood contains an allergen that reacts to the recipient’s preformed antibodies, then the patient could experience an allergic reaction to the blood transfusion. The provider may think the patient is experiencing an allergic reaction to the transfusion if the patient is exhibiting any of the following conditions:

• Angioedema (swelling under the skin)
• Bronchospasm (tightening of the airway muscles)
• Hypotension
• Urticaria (hives)/pruritus (itchy skin)

In other words, the provider’s TAD diagnosis should be given only when there aren’t other symptoms along with the patient’s breathing difficulties following the transfusion.

Understand the New Diagnosis Code for 2023

Effective Oct. 1, 2022, you’ll assign J95.87 (Transfusion-associated dyspnea (TAD)) on your claim when a provider diagnoses a patient with TAD. “The introduction of a condition-specific code will help improve coding accuracy and allow for a better understanding of this [condition] and will therefore help in the development of appropriate prevention and strategies,” Young added.

The 2023 ICD-10-CM code set also features an Excludes1 note listed under J95.87, which instructs you to not code TACO or TRALI diagnoses along with TAD. This falls in line with how a provider arrives at a TAD diagnosis, since the patient should be experiencing only respiratory distress and no other symptoms.

The Excludes1 note below J95.87 features the following ICD-10-CM codes:

• E87.71 (Transfusion associated circulatory overload)
• J95.84 (Transfusion-related acute lung injury (TRALI))

“Remember — Excludes1 is telling you if you’re looking for [the listed] information, you’re in the wrong place,” Young said.

If you notice the provider’s documentation lists TAD as the diagnosis, but also calls out other symptoms like fever, hypotension, hypertension, or fluid overload, you might consider querying the provider to confirm the diagnosis.

Code This Blood Transfusion Reaction Scenario

Scenario: A patient visits an outpatient clinic for a blood transfusion because of anemia due to their chronic kidney disease. The procedure went well, and the patient was discharged. Approximately 12 hours later, the patient presents to the emergency department (ED) complaining of SOB. The attending physician performs a physical evaluation and notes the patient temperature is 97 degrees, blood pressure is 178/79, SpO₂ is 97 percent, and the patient’s skin appears normal. The physician then diagnoses the patient with TAD.

For this scenario, you’ll assign J95.87 for the patient’s TAD diagnosis. The patient underwent a blood transfusion less than 24 hours ago and was only experiencing SOB. If the patient experienced a fever and elevated blood pressure, you would assign E87.71 if the provider diagnosed the patient with TACO. If the patient presented with low blood pressure and an elevated temperature, then you’d assign J95.84 if the provider diagnosed the patient with TRALI.

However, if the physician documented that the patient’s condition was a result of an allergic reaction to the transfusion, you could assign any of the following codes, if appropriate:

• L50.0 (Allergic urticaria)
• L29.8 (Other pruritus)
• J98.01 (Acute bronchospasm)
• T78.3XX- (Angioneurotic edema) or allergic angioedema
• I95.89 (Other hypotension)