Pulmonology Coding Alert

Acute and chronic cough might be coded differently if the proposals are finalized.

Cough coding could be set for a big overhaul as part of the Oct. 1, 2019 ICD-10 update. That’s the word from the proposals that the ICD-10 Coordination and Maintenance Committee discussed during its March meeting.

The Committee will not make final decisions until later this year, but the following proposals are on the table and could impact pulmonology practices nationwide if they are approved.

Pinpointing Cough Type

Most pulmonologists see patients who complain of coughing on a daily basis, which leaves you with one major code, R05 (Cough). Of course, you can code more specifically if the patient has a cough with hemorrhage (R04.2) or a smoker’s cough (J41.0), but when it comes to getting down to the type of cough – acute, subacute, or chronic – you don’t have a lot of options. Therefore, codes for these conditions have been proposed for 2020.

“Creating new codes for acute, subacute, and chronic cough will ensure the ICD-10-CM is better aligned with the current clinical guidelines for cough,” the notes from the Coordination and Maintenance Committee Meeting state.

Merck requested new codes for this condition, and the American Thoracic Society, CHEST, American College of Allergy, Asthma and Immunology, American Lung Association, American Academy of Allergy, Asthma and Immunology, and the Permanente Federation all support the proposal. The new code suggestions are as follows:

• R05.1 -- Acute cough (Cough of less than three weeks duration)
• R05.2 – Subacute cough (cough of three to eight weeks duration)
• R05.3 – Chronic cough (Cough of more than eight weeks duration [> four weeks in pediatrics]) (cough, persistent) (cough syncope) (paroxysmal cough) (refractory) (unexplained chronic cough)
• R05.9 – Cough of unspecified duration

It remains to be seen whether these proposals will be approved and added to the 2020 edition of the ICD-10 manual, but the codes should be addressed at the committee’s next meeting, which takes place in September. Keep an eye on Pulmonology Coding Alert for more on this issue.