Pulmonology Coding Alert

The 2019 diagnosis codes include over 300 additions.

Sometimes, pulmonology practices wish for a plethora of new diagnosis codes to bolster their claims, while other years, the existing diagnoses suffice and coders are happy not to have hundreds of new ICD-10 codes to learn. This year leans more toward the latter situation -- 320 new diagnosis codes will debut on Oct. 1, and 172 codes have been revised, but the changes will not dramatically impact pulmonology offices.

CMS published the full listing of new, deleted, and revised codes in mid-June, but we’ve reviewed the list to identify the changes most relevant to lung care offices. Although you won’t find new codes for services you most frequently perform, there are some codes for services you may see from time to time, and it’s important to get a handle on what they are.

Check out Post-Procedural Infection Codes

Effective Oct. 1, you’ll find coding updates that allow additional specificity in post-procedural infection coding. Three codes are scheduled for deletion in this category: T81.4XXA (Infection following a procedure, initial encounter), T81.4XXD (Infection following a procedure, subsequent encounter), and T81.4XXS (Infection following a procedure, sequela).

To replace these deleted codes, ICD-10 is going infinitely more granular. You’ll find over 20 new codes that describe more specifics of the post-procedural infection or other condition, all of which fall under the following parent codes:

• T81.40 -- Infection following a procedure, unspecified
• T81.41 -- Infection following a procedure, superficial incisional surgical site
• T81.42 -- Infection following a procedure, deep incisional surgical site
• T81.43 -- Infection following a procedure, organ and space surgical site
• T81.44 -- Sepsis following a procedure
• T81.49 -- Infection following a procedure, other surgical site

The above codes represent the primary new codes, each of which will expand out to additional characters to describe whether the encounter was initial, subsequent, or for sequela. An example from the T81.40 section follows:

• T81.40XA -- Infection following a procedure, unspecified, initial encounter
• T81.40XD -- Infection following a procedure, unspecified, subsequent encounter
• T81.40XS -- Infection following a procedure, unspecified, sequela

The additional codes in the series follow this lead, with the “A,” “D,” and “S” seventh character designations.

Check This Example

Consider the following example to see how you may encounter postsurgical infection billing:

A patient was hospitalized for a pulmonary embolism, and a surgeon removed the clot and inserted a filter to prevent any future issues. The patient presents to your practice several weeks after the procedure for a planned transfer of care from the surgeon. The pulmonologist notices that the patient has swelling, pus and inflammation at the surgical site. She asks the patient if he has shown the surgeon the issue and the patient says he cancelled his follow-up with the surgeon due to scheduling issues and planned to only continue follow-up with the pulmonologist.

The pulmonologist prescribes an antibiotic and contacts the surgeon’s office to arrange for a complete post-surgical follow-up later that day. The pulmonologist will link the visit to T81.41XA (Infection following a procedure, superficial incisional surgical site, initial encounter).

Resource: To access the entire list of new, revised, and deleted ICD-10 codes, visit the CMS website at www.cms.gov/Medicare/Coding/ICD10/2019-ICD-10-CM.html.