Pulmonology Coding Alert

Remember to use J65 for tuberculosis-related diagnoses.

Patients suffering from pneumoconiosis are noticing its effects after years of exposure to the harmful dust. As a pulmonology coder, you’ll need to know the different pneumoconiosis types and the codes for each one to ensure accurate reporting.

Check out our coding refresher on this complicated condition.

Get to Know Pneumoconiosis

Pneumoconiosis is a type of an interstitial lung disease (ILD) that develops when the patient inhales certain dusts. The condition commonly occurs due to dust exposure in the workplace and takes years to develop. A patient’s risk of developing the disease increases with prolonged exposure to the dust and if they are a smoker.

Pneumoconiosis symptoms include cough, shortness of breath, fatigue, and phlegm production. Typically, a pulmonologist orders chest X-rays or a chest CT scan to evaluate the lungs.

Build Your Black Lung Disease Coding Expertise

You’ll assign J60 (Coalworker’s pneumoconiosis) for a coal worker’s pneumoconiosis diagnosis. This pneumoconiosis type develops as the patient inhales coal, graphite, or manmade carbon dust over extended periods of time, and the patient’s risk of developing the condition depends on how much time is spent around the dust.

At the same time, your pulmonologist may diagnose the condition as anthracosilicosis, anthracosis, black lung disease, or coal worker’s lung. All these conditions are coded to J60 as the diagnoses are listed as synonyms.

When the healthcare provider documents that the patient is experiencing pneumoconiosis as a result of exposure to asbestos or other mineral fibers, you’ll assign J61 (Pneumoconiosis due to asbestos and other mineral fibers) to report the diagnosis. You’ll also use J61 if the physician’s diagnosis is asbestosis.

Use a 4^th Character to Report Certain Dust-Related Pneumoconiosis

If the physician documents that the patient’s pneumoconiosis is caused by silica dust, then you’ll assign a code from the J62.- (Pneumoconiosis due to dust containing silica) subcategory. Symptoms of this condition include shortness of breath, wheezing, and a cough.

Parent code J62.- features a 4th character required icon to indicate an additional character is needed to complete the code. The subcategory includes two separate codes to identify the type of dust that contains silica:

• J62.0 (Pneumoconiosis due to talc dust)
• J62.8 (Pneumoconiosis due to other dust containing silica)

You’ll also assign J62.8 to report a silicosis not otherwise specified (NOS) diagnosis.

Code subcategory J63.- (Pneumoconiosis due to other inorganic dusts) is reserved for diagnoses where the patient is experiencing pneumoconiosis caused by dusts that don’t contain carbon, aside from select simple carbon oxides. You’re also required to use a 4th character to complete the codes within the J63.- subcategory:

• J63.0 (Aluminosis (of lung))
• J63.1 (Bauxite fibrosis (of lung))
• J63.2 (Berylliosis)
• J63.3 (Graphite fibrosis (of lung))
• J63.4 (Siderosis)
• J63.5 (Stannosis)
• J63.6 (Pneumoconiosis due to other specified inorganic dusts)

Also, what code family in the ICD-10-CM code set would be complete without an unspecified code? The pneumoconiosis code family is no different. You’ll assign J64 (Unspecified pneumoconiosis) when the physician documents a pneumoconiosis diagnosis, but the specific type is unknown.

Take Note of This Tuberculosis Trick

You’ll assign J65 (Pneumoconiosis associated with tuberculosis) if the patient is experiencing pneumoconiosis that is connected to tuberculosis. Essentially, if the patient is diagnosed with any pneumoconiosis condition coded to J60-J64 that is also tied to a tuberculosis diagnosis, coded to the A15.- (Respiratory tuberculosis) category, then you’ll report J65.

Excludes1: Code J65 is listed as an Excludes1 code for J60-J64, so each code subcategory directs you to J65 if tuberculosis is also a factor.

Put Your Knowledge to the Test

Scenario: A 65-year-old patient presents to their primary care physician (PCP) with complaints of cough, wheezing, and shortness of breath. The patient is retired but worked as a smelter of bauxite. The PCP refers the patient to a pulmonologist for further evaluation. The pulmonologist orders chest X-rays, which revealed lung fibrosis. The pulmonologist diagnosed the patient with bauxite pneumoconiosis.

You’ll assign J63.1 to report the bauxite pneumoconiosis diagnosis. Code J63.1’s descriptor is listed as bauxite fibrosis of the lung, but when you search the ICD-10-CM Alphabetic Index for Pneumoconiosis > bauxite, you’re directed to J63.1.