Pulmonology Coding Alert

Documentation will be key to finding info to determine the right codes.

As many coders may remember, last year brought the introduction of over a dozen codes that described pulmonary embolism and deep vein thrombosis — and although the codes debuting this year aren’t as numerous, they’re just as important to know when you’re updating your systems.

Background: On July 1, CMS released the new ICD-10-CM codes and descriptors, with a total of 490 additions, 58 code deletions, and 47 revisions that will go into effect on October 1. Although there aren’t hundreds of code changes impacting pulmonology practices this year, the ones that are debuting will allow you to get much more specific on your claims.

Check Big Changes to the J82 Range

Some of the changes to the 2021 code set are the result of stakeholder requests made at last year’s ICD-10-CM Coordination and Maintenance Committee (ICMC) Meeting, during which the ICMC’s David Berglund, MD offered some insight into the following new code additions.

You’ll find a significant expansion of the codes in the J82 (Pulmonary eosinophilia) code range, giving you a fourth character to report, based on the effect of the eosinophilia, as follows:

• J82.81 (Chronic eosinophilic pneumonia)
• J82.82 (Acute eosinophilic pneumonia)
• J82.83 (Eosinophilic asthma)
• J82.89 (Other pulmonary eosino­philia, not elsewhere classified)

“Eosinophilia generally means elevated blood levels of eosinophils, while pulmonary eosinophilia refers to infiltration of eosinophils into the lungs,” Berglund said at the meeting. “There are two types of eosinophilic pneumonia — acute and chronic. While both are characterized by eosinophil invasion of the lung tissue, they are quite different from one another.”

This explains the introduction of the separate codes describing the acute and chronic conditions. In addition, he added, eosinophilic asthma is a leading cause of severe asthma, and can be difficult to treat, making it necessary for codes to describe these specific conditions. “The symptoms of eosinophilic asthma differ from classic asthma and, in fact, more closely resemble those of chronic pulmonary obstructive disorder (COPD),” he noted.

Check Updates to J84.17 Code Listings

Pulmonology coders will also get a revision to code J84.17 (Other interstitial pulmonary diseases with fibrosis in diseases classified elsewhere), which has been converted to a parent code. This new specificity paves the way for two new codes to debut under it, as follows:

• J84.170 (Interstitial lung disease with progressive fibrotic phenotype in diseases classified elsewhere)
• J84.178 (Other interstitial pulmonary diseases with fibrosis in diseases classified elsewhere)

These new codes will allow practices to differentiate between the type and cause of interstitial pulmonary diseases, based on whether fibrosis and/or a progressive fibrotic phenotype was present.

Other new codes now official: As part of the update to the ICD-10 codes, you’ll also find both U07.0 (Vaping-related disorder) and U07.1 (COVID-19) on the list of new diagnoses. These both took effect earlier in 2020, but the new code set indicates that they will be listed in ICD-10-CM code books for the coming year.

Resource: To read the entire new ICD-10 code set, visit the CMS website at https://www.cms.gov/medicare/icd-10/2021-icd-10-cm.