Pulmonology Coding Alert

ICD-10-CM Coding Quiz:

Dive Into the Descriptors to Understand the Differences in Bronchitis Codes

Learn the difference between J41.0 and J20 bronchitis codes.

The respiratory system consists of complicated structures that can make life hard for the patient if any of them become damaged, inflamed, or infected. Whether you’re new to the field or a seasoned professional, your job as a pulmonology coder is to ensure you’re reporting the correct codes to provide accurate reimbursement for your practice.

Put your respiratory diagnoses coding skills to the test with these three scenarios.

Choose the Correct Chronic Bronchitis Code

Scenario: A 35-year-old patient comes into your pulmonology practice presenting symptoms of frequent coughing and the production of clear mucus. The symptoms have persisted for three months and the patient has a history of bronchitis. Additionally, even though the patient confirms they are a cigarette smoker, they haven’t had trouble breathing. After performing chest X-rays and pulmonary function tests, the physician diagnoses the patient as having chronic bronchitis.

What ICD-10-CM code will you use for the diagnosis?

A) J41.0

B) J20

C) J45.909

D) J43.8

Answer: A. The physician diagnoses the patient with chronic bronchitis, but other factors will guide you to the correct code. The patient states they have been suffering from a frequent cough and clear mucus production for three months, but they are not experiencing shortness of breath. This information leads you to use J41.0 (Simple chronic bronchitis) to document the diagnosis.

While J20 (Acute bronchitis) is a bronchitis code, the difference is in the wording of the descriptor. Acute is included, which indicates a cough that lasts for several weeks and is not recurring. ICD-10-CM codes J45.909 (Unspecified asthma, uncomplicated) and J43.8 (Other emphysema) are respiratory diseases, but do not fit the symptoms that the patient states they are experiencing.

Check the Code Notes to Accurately Document the Flu and Pneumonia

Scenario: A patient has been experiencing flu-like symptoms, including a fever of more than 100°F, chills, coughing, runny nose, and aches. The symptoms have persisted for a week, and now they are experiencing shortness of breath, a sharp chest pain that worsens when they inhale deeply or cough, and a mucus-producing cough. The patient’s primary care physician (PCP) diagnoses them as having influenza type B and refers them to your pulmonology practice to check for the presence of pneumonia. The pulmonologist orders blood tests, chest X-rays, and pulse oximetry. After reviewing the results, the physician diagnoses the patient as having bacterial pneumonia as a result of the flu.

What ICD-10-CM codes will you use to document the diagnoses?

A) J10.1, J15.9

B) J09.X1, J15.9

C) J11.1, J12.0

D) J11.2, J13

Answer: A. In this scenario, the physician diagnoses the patient as having influenza type B virus and bacterial pneumonia. To find the appropriate influenza ICD-10-CM code, you’ll want to look to the applicable parent code notes. Code J09. X1 (Influenza due to identified novel influenza A virus with pneumonia) carries an Excludes1 note that eliminates influenza type A, as this code reflects a diagnosis of novel influenza A virus with pneumonia. Code J10.1 (Influenza due to other identified influenza virus with other respiratory manifestations) features an Includes note that calls out influenza B. There aren’t parent code notes for J11.1 (Influenza due to unidentified influenza virus with other respiratory manifestations) and J11.2 (Influenza due to unidentified influenza virus with gastrointestinal manifestations), but the descriptors call out “unidentified influenza virus,” which is incorrect for this scenario as the flu strain was identified by the PCP.

For the bacterial pneumonia diagnosis, you’ll use J15.9 (Unspecified bacterial pneumonia) on your report. Additionally, you’ll find a note stating that you’ll report the associated influenza code first. In summary, you’ll code the diagnoses for this patient as J10.1, J15.9.

Extinguish Smoke Inhalation Coding Fires

Scenario: Your pulmonologist sees a patient who is presenting symptoms of coughing, shortness of breath, a scratchy throat, headaches, and irritated sinuses. During the medical history, the patient states they are a firefighter and have been battling wildfires in the area. The pulmonologist orders a CT scan to check for additional damage to the patient’s lungs. The physician doesn’t find any internal damage and diagnoses the patient as experienced smoke inhalation.

What ICD-10-CM code will you use to report the diagnosis?

A) J70.5

B) J70.4

C) J70.0

D) J70.3

Answer: None. This is a trick question. Smoke inhalation occurs when the patient breathes in smoke and the products of combustion during a fire. For this scenario, you’ll use J70.5 (Respiratory conditions due to smoke inhalation) to code the diagnosis. However, the notes under the descriptor instruct you to use the appropriate code from the T59.81- (Toxic effect of smoke) family first. In this case, you would use T59.811A (Toxic effect of smoke, accidental (unintentional), initial encounter) as the inhalation of smoke was a hazard of the patient’s occupation.

Codes J70.3 (Chronic drug-induced interstitial lung disorders) and J70.4 (Drug-induced interstitial lung disorders, unspecified) deal with interstitial lung diseases caused by antibiotics, chemotherapy drugs, statins, and antiarrhythmic agents. Code J70.0 (Acute pulmonary manifestations due to radiation) covers symptoms, such as cough, dyspnea, chest discomfort, pleuritic pain, and a low-grade fever following the completion of a radiotherapy course.

In summary, you’ll code this diagnosis as T59.811A, J70.5.