Pulmonology Coding Alert

Hint: Some codes won't fall under the J15 section of ICD-10.

Your pulmonology practice is likely to diagnose pneumonia on a frequent basis, but coding the visit isn't as simple as reporting J15 and moving on. There are multiple types of pneumonia and the condition can be caused by a wide variety of organisms. Check out the following three pneumonia cases and determine how you would code these visits before checking out our expert advice.

Lobar Pneumonia

Scenario:  A 66-year-old patient presents complaining of increased sputum with a reddish-orange tint to it, pain when coughing, shallow breathing, nausea, and fever. The pulmonologist examines the patient, orders a chest x-ray, and sends cultures and samples for further testing. The diagnosis comes back as lobar pneumonia affecting the left inferior lobe. Which code should youreport?

Coding solution: Unfortunately, the case study does not indicate the organism that caused the lobar pneumonia. Because the physician sent cultures to a lab, this information should be in the record somewhere, and would help drive the code that you'll report for the service. In some cases, however, the organism is not identified and only the unspecified code can be billed.

If you are unable to find documentation of the organism, you'll be forced to report J18.1 (Lobar pneumonia, unspecified organism).

RSV Pneumonia

Scenario: A seven-year-old patient presents with wheezing, rapid breathing, and tachypnea. The pulmonologist takes a culture and orders a chest x-ray, eventually diagnosing the patient with respiratory syncytial virus that has spread to the lower respiratory tract, causing pneumonia. The physician prescribes antibiotics and asks the patient to return in four days for a recheck.

Coding Solution: In this scenario, you don't need to report separate codes to reflect both the RSV and the pneumonia. Instead, the ICD-10 manual provides you with one combination code – J12.1 (Respiratory syncytial virus pneumonia). This is the best code to describe the patient's condition.

Lymphoid Interstitial Pneumonia

Scenario: A 59-year-old male patient arrives with complaints of increasing dyspnea, chronic cough, and fever. Your pulmonologist performs a thorough evaluation, noting parotid enlargement, hepatosplenomegaly, and presence of lymphadenopathy. He orders a chest x-ray and pulmonary function tests to check for diffusing capacity and determination of lung volumes. He sends biopsy samples to the lab for histological studies, and subsequently confirms a diagnosis of idiopathic lymphoid interstitial pneumonia.

Coding Solution: To report this condition, you'll assign code J84.2 (Lymphoid interstitial pneumonia), which isn't actually included in the pneumonia section of the ICD-10 manual. Instead, you'll find it in the "Other interstitial pulmonary diseases" section of the book.