Pulmonology Coding Alert

Evaluate your ICD-10 knowledge with this quick quiz.

It can be daunting to select an ICD-10 code among the thousands of options in your coding manual, but the truth is that your claims success depends on the fact that you know these codes as well as you know those in CPT^®. After all, your diagnosis codes are what insurers use to confirm that your services were medically necessary, so your income depends on making sure your ICD-10 knowledge is top-notch.

Check out the following five ICD-10 coding questions and determine how you'd code these conditions, and then turn to page 29 to read the answers.

Potential Acute Respiratory Distress Syndrome

Question 1:  The pulmonologist sees a 64-year-old female patient in the hospital for complaints of severe dyspnea and agitation. The physician performs a comprehensive history and examines the patient. During examination, the patient appears to be in a state of anxiety. Your pulmonologist notes presence of cyanosis and tachycardia. Upon auscultation, he notes the presence of fine bilateral rales.

Your pulmonologist suspects acute respiratory distress syndrome and sends an arterial blood sample to the lab for analysis of blood gases. He also orders a chest x-ray and echocardiography, as well as CBC, kidney, and liver function tests. The blood gas analysis and chest x-ray further prompt the physician to suspect acute respiratory distress syndrome, so he performs a bronchoscopy with lavage. The lab results indicate that the fluid is positive for increased eosinophil counts. Based on the history, signs and symptoms, physical examination, results from tests and bronchoscopy, your pulmonologist arrives at a diagnosis of acute respiratory distress syndrome.

Which code should you report for ordering the lab tests? And which diagnosis code applies to the final diagnosis?

Infant With Acute Bronchiolitis

Question 2: Your pulmonologist is called in to assess a seven-month-old infant admitted to the hospital for irritability, fussiness, and feeding problems. The infant's mother also says the child is experiencing breathing difficulties and makes wheezing sounds during breathing.

Your pulmonologist performs a thorough recording of the patient's history and an examination. He observes elevated temperature, tachypnea, and tachycardia in the documentation and notes fine wheezing sounds heard on auscultation.

Based on the age of the patient, symptoms, and the occurrence of episodes of acute bronchiolitis in the particular season, your pulmonologist arrives at a preliminary diagnosis of acute bronchiolitis. The lab confirms a diagnosis of acute bronchiolitis due to respiratory syncytial virus. Which ICD-10 code should you report for the final diagnosis?

Suspected EAA, Confirmed Suberosis

Question 3: A 55-year-old patient arrives at your office with cough, dyspnea, fever with chills, malaise, and headache. Your pulmonologist performs a thorough evaluation, and during the history portion, the patient reveals that he worked as a cork handler for over a decade. This occupational history makes your pulmonologist suspicious of extrinsic allergic alveolitis.

To confirm the diagnosis, your pulmonologist orders blood tests and PFTs such as spirometry, diffusing capacity, respiratory flow volume, and determination of lung volumes. He also performs a bronchoscopy and orders a chest x-ray. Based on history, observations made at physical examination and test results, your pulmonologist is able to confirm a diagnosis of suberosis. Which code describes this condition?

Pyothorax Without Fistula

Question 4: A 64-year-old patient presents with complaints of severe cough and shortness of breath. He also notes intermittent fever for the past few days, although the temperature recorded presently is near normal. Upon auscultation, your pulmonologist notes dull breath sounds and dull percussion note.

An x-ray confirms the presence of fluid in the pleural space, so the pulmonologist performs thoracentesis. Based on the laboratory findings, your pulmonologist confirms a diagnosis of pyothorax, but the documentation does not mention the presence of a fistula in the documentation. How should you report this diagnosis?

Question 5: A 47-year-old male patient arrives at your pulmonologist's office with complaints of breathing difficulties and chest tightness. He complains that he has been having these symptoms for over a month, and of late the symptoms have increased and have been affecting his work and day-to-day life. He also mentionsthat he seems to be having these symptoms more during the start of the week and then it seems to stabilize for a few days and he feels better during the rest of the week.

Upon questioning, your pulmonologist notes that the patient has been working as a handler of raw cotton for more than a decade. Based on this history of working in the cotton industry and the signs and symptoms, your pulmonologist suspects a diagnosis of byssinosis. On examination, your pulmonologist notes wheezing and reduced lung expansion during breathing. The pulmonary function tests, chest x-ray, and lab tests allow the physician to confirm the byssinosis diagnosis. Which code applies to this diagnosis?