Pulmonology Coding Alert

Don’t mix up these two conditions.

Maintaining an optimal level of carbon dioxide in the blood is essential to patients’ health, and too much or too little can create massive problems that the pulmonologist must address. When these conditions arise, you may be called upon to select codes describing acidosis or alkalosis – but first, you must know that these conditions are somewhat opposite each other, so never confuse the two when assigning ICD-10 codes.

Acidosis Primer

Sometimes, excess carbon dioxide (CO2) collects in the blood of a patient, which usually is a classic presentation of respiratory acidosis. The excess CO2 causes a depletion of the blood’s pH level. The increased CO2 can be caused due to many reasons such as upper or lower airway obstruction, acute lung infections or inflammation, bronchial tissue infections and other acute or chronic lung conditions. The correct code for this condition is E87.2 (Acidosis).

Treat the Underlying Condition

When too little carbon dioxide raises the pH level in a patient’s blood, the patient may have respiratory alkalosis, which you currently code with E87.3 (Alkalosis).

Usually, when you report alkalosis, the accompanying symptoms are hyperventilation (R06.4) and light-headedness (R42). The physician’s treatment options involve treating the underlying condition.

ICD-10 Codes in Real-Life Coding Scenario

You may see many signs and symptoms that make your pulmonologist decide on an acidosis or alkalosis diagnosis, but you should bridge only the primary condition and the procedure codes.  

Case: A patient presents with severe asthma (J45.xx) and develops fever (R50.9), wheezing (R06.2) and fatigue (R53.83). Tests confirm a diagnosis of acidosis (E87.2). The physician inserts an endotracheal tube (31500, Intubation, endotracheal, emergency procedure) during treatment.

Do it yourself: Although you can code J45.xx for the asthma, R50.9 for the fever, R06.2 for wheezing and R53.83 for fatigue, make sure to connect your procedure code (31500) to the acidosis code E87.2.