Pulmonology Coding Alert

Scenario: Your pulmonologist sees a patient who’s complaining of a dry cough, fatigue, chest pain, shortness of breath, and has noticed significant weight loss. After an initial examination, the physician asks the patient what he does for a living. The patient replies he works in a factory assembling electronic components. The physician orders a beryllium lymphocyte proliferation test (BeLPT) (86353 Lymphocyte transformation, mitogen (phytomitogen) or antigen induced blastogenesis) to examine if the lymphocytes are reacting to the presence of beryllium. When the test returns a positive result, the pulmonologist orders additional X-rays and a pulmonary function test (PFT). The physician concludes the patient has chronic beryllium disease (CBD).

You won’t find a specific ICD-10-CM code for CBD, but J63.2 (Berylliosis) is a sufficient match to report the diagnosis. Berylliosis occurs when the patient inhaling beryllium dusts, vapors, or its compounds, which is usually due to occupational exposure. A metallic element, beryllium is a material used in dental alloy preparation, metals extraction, electronics, and more.

Excludes1 note: Code J63.2 carries an Excludes1 note for pneumoconiosis with tuberculosis for any type in J65 (Pneumoconiosis associated with tuberculosis) or A15 (Respiratory tuberculosis).

Coding Bird Fancier’s Lung is All in a Day’s Work

Hypersensitivity pneumonitis is a rare disorder that causes lung inflammation from a variety of sources. By repeatedly inhaling antigenic agents and not treating it, the patient could face inflammation that may cause permanent scarring in the lungs. Microbes, animal proteins, and low-molecular-weight chemicals are the major categories of antigens.

Scenario: A patient arrives at your practice with inflammation of the lungs, and is experiencing pain while breathing, dry cough, chills, and a fever. The patient keeps and raises parakeets and pigeons as a hobby. After chest X-rays, the pulmonologist diagnoses the patient with bird fancier’s lung.

Bird fancier’s lung (J67.2) falls under the J67.- (Hypersensitivity pneumonitis due to organic dust) code family. The parent code, J67.-, carries a symbol that indicates an additional 4th character is required for proper reporting.

While the patient is diagnosed with bird fancier’s lung in this scenario, you will find several other specific diagnoses in this code family that are the result of environmental factors and fall under the hypersensitivity pneumonitis classification. These codes include:

• J67.0 (Farmer’s lung)
• J67.1 (Bagassosis)
• J67.3 (Suberosis), which is also known as Corkworker’s disease
• J67.4 (Maltworker’s lung)
• J67.6 (Maple-bark-stripper’s lung)
• J67.8 (Hypersensitivity pneumonitis due to other organic dusts)

The last ICD-10-CM code of that list, J67.8, also carries additional descriptors, such as Cheese-washer’s lung, Coffee-worker’s lung, Fish-meal worker’s lung, and Furrier’s lung, which the physician could document in their report.

However, if the pulmonologist diagnoses the patient with hypersensitivity pneumonitis, but his documentation doesn’t appear to specify a concrete reason as to why, then you will choose J67.9 (Hypersensitivity pneumonitis due to unspecified organic dust).

Pay Attention to the Affected Areas to Determine Sarcoidosis Dx

Another rare disease that affects the lungs is sarcoidosis. Sarcoidosis involves the growth of inflammatory cells, granulomas, which some experts believe are the result of chemicals, dust, infectious agents, or an abnormal reaction to the patient’s own proteins, if they’re genetically predisposed. “We don’t have a specific way of making the diagnosis because we don’t know the cause,” says Robert P. Baughman, MD at the University of Cincinnati in a webinar for the American Thoracic Society (URL: www.thoracic.org/patients/lung-disease-week/2018/sarcoidosis-week/webinar.php), “The major thing a physician looks for is the presence of noncaseating granulomas, and you want to look to make sure there’s no other cause of the granulomas, such as tuberculosis or beryllium.”

Scenario: A 45-year-old patient is referred to your pulmonology practice by their primary care physician (PCP). The patient is suffering from shortness of breath, chest pain, wheezing, and a constant dry cough. The pulmonologist orders chest X-rays, and notices tiny collections of inflammatory cells on the results. The patient is diagnosed with sarcoidosis of the lungs.

Sarcoidosis can affect multiple body systems, including the heart, eye, and skin. The ICD-10-CM code set has a parent code for this condition, D86.- (Sarcoidosis), which carries a symbol to indicate that a 4th character is required for accurate reporting. In this scenario, you’ll use D86.0 (Sarcoidosis of lung) to report the patient’s diagnosis. You would use D86.2 (Sarcoidosis of lung with sarcoidosis of lymph nodes) if the physician conducted further testing and discovered the patient’s lymph nodes were also infected with the disease.