Pulmonology Coding Alert

Take a closer look at NOS codes to shore up.

Your success in 2017 will largely depend on your capacity to code to the maximum specificity level possible. What do you do if the provider just writes off an inconclusive diagnosis — say a sore throat?

Tip: Know the keywords you need to find in the documentation. Terms such as acute, chronic, or recurrent may hold the key to the coding puzzle.

Read on for a few such common scenarios and the magic keywords like acute, chronic, recurrent to steer your code selection.

Test Your Coding Skill in Pansinusitis

Question: The provider note for a patient reads “pansinusitis.” How do you code this?

Pansinusitis means inflammation of the air filled spaces beneath the facial contours. Here, you will need to dig into the notes further to identify whether the sinusitis was sudden onset or acute; or whether it was longstanding or chronic.

There can be only three possibilities:

1. You are able to identify this to be an acute case. The code category you are looking for is J01.4- (Acute pansinusitis…). Try to search further to confirm if the pansinusitis is a recurrent problem for the patient. Based on these key points in the diagnosis note, you will need to pick from one of the two codes:

• J01.40 (Acute pansinusitis, unspecified)
• J01.41 (Acute recurrent pansinusitis)

2. If it is a case of chronic pansinusitis, you would code it as J32.4 (Chronic pansinusitis).

3. If your provider does not mention the type at all, you may consider it as not otherwise specified and code it as J32.4 (Pansinusitis NOS). In the case described above, since the provider has not mentioned any details about the pathology, it would be safe to code it as J32.4.

Know What Codes Link to a Sore Throat

Question: The provider mentions that the patient has a sore throat. Which code will be most appropriate?

You will need to review the documentation of sore throat, or pharyngitis, in a bit of detail, to be able to get to the most appropriate code here.

If the provider says the patient suffers from a recent onset sore throat, the code category to follow would be J02.- (Acute pharyngitis), signifying an acute sore throat. If the provider mentions presence of a Streptococci, then you may think of J02.0 (Streptococcal pharyngitis) for a streptococcal sore throat.

If the provider mentions that it’s an acute sore throat, but mentions little else, you may need to look up sore throat (acute), NOS, and report J02.9 (Acute pharyngitis, unspecified).

If it’s a chronic case of sore throat, you may report J31.2 (Chronic pharyngitis).

“Be sure that the documentation is present to support the code selection, says Carol Pohlig, BSN, RN, CPC, ACS, senior coding and education specialist at the Hospital of the University of Pennsylvania. “ If the physician is trying to ‘rule out strep throat,’ do not select code J02.0 unless the test results have confirmed strep throat.”

“It’s important to find the ICD-10 codes that most closely represents the patient’s diagnosis,” says Jeff Berman, MD, FCCP,  executive director of the Florida Pulmonary Society. “Try to utilize the most specific code that represents the primary diagnosis. Some codes may include multiple diagnoses, such as in [this] example.”

Final takeaway: “As we become familiar with the many ICD-10 codes and their associations, remember to look at the documentation before settling on an unspecified (default) code,” says Pohlig. “Query the physician to ensure that the documentation is complete. Verify that the determined code is accurate, and you are not assigning a diagnosis that is inappropriate for the patient’s condition. ICD-10 coding takes effort, communication, and education of all parties involved.”