Pulmonology Coding Alert

Major revisions to postprocedural hemorrhage, mediastinitis, and more.

CMS finally released the definitive codeset update for the new 2017 ICD-10-CM codes that will go into effect Oct. 1.

“New codes always require adjustment of reporting practices since people have to ‘break the habit’ of reporting the circumstances in the manner that they did prior to the new codes,” says Carol Pohlig, BSN, RN, CPC, ACS, senior coding and education specialist at the Hospital of the University of Pennsylvania. Here’s your crisp and short analysis on how to grab the main points of the revisions, deletions, and new additions that will affect your coding.

Replace “Tobacco Use” With “Tobacco Dependence”

“There are a number of significant revisions and additions to the 2017 ICD-10 Pulmonary codes, which are more disease specific, while adding more complexity to the coding process,” says Jeff Berman, MD, FCCP, executive director of the Florida Pulmonary Society.

For most of the codes in Chapter 10, Diseases of the Respiratory System (J00-J99), the “use additional” term has been revised from “history of tobacco use” (Z87.891) to “history of tobacco dependence” (Z87.891). This revision encompasses all J codes that listed Z87.891 as an additional term, covering:

Other diseases of upper respiratory tract (J30-J39):

• J31, Chronic rhinitis, nasopharyngitis and pharyngitis
• J32, Chronic sinusitis
• J33, Nasal polyp
• J35, Chronic diseases of tonsils and adenoids
• J37, Chronic laryngitis and laryngotracheitis
• J38, Diseases of vocal cords and larynx, not elsewhere classified

Chronic lower respiratory diseases (J40-J47):

• J40, Bronchitis, not specified as acute or chronic
• J41, Simple and mucopurulent chronic bronchitis
• J42, Unspecified chronic bronchitis
• J43, Emphysema
• J45, Asthma
• J47, Bronchiectasis

From other categories:

• J81, Pulmonary edema
• J98, Other respiratory disorders.

Look Out For Other Revisions

Here are some more revisions to look out for:              

• In J44 (Other chronic obstructive pulmonary disease) delete the Excludes1 note of “lung diseases due to external agents (J60-J70)” and add an Excludes2 notes of “lung diseases due to external agents (J60-J70).”
• For J47.0 (Bronchiectasis with acute lower respiratory infection), add “Use additional code to identify the infection.”
• As for code J84.89 (Other specified interstitial pulmonary diseases), delete “Organizing pneumonia due to known underlying cause” from its extended descriptor.
• Revise J95.83 from “Postprocedural hemorrhage and hematoma of a respiratory system organ or structure following a procedure” to “Postprocedural hemorrhage of a respiratory system organ or structure following a procedure.”
• Revise J95.830 from “Postprocedural hemorrhage and hematoma of a respiratory system organ or structure following a respiratory system procedure” to “Postprocedural hemorrhage of a respiratory system organ or structure following a respiratory system procedure.”
• Revise J95.831 from “Postprocedural hemorrhage and hematoma of a respiratory system organ or structure following other procedure” to “Postprocedural hemorrhage of a respiratory system organ or structure following other procedure.”

Get To Know This Mixed Bag of New Codes

Apart from the en bloc revisions of codes, the update also promises pulmonology coders some fresh codes to add to their superbills. These include:

• J95.86, Postprocedural hematoma and seroma of a respiratory system organ or structure following a procedure
• J95.860, Postprocedural hematoma of a respiratory system organ or structure following a respiratory system procedure
• J95.861, Postprocedural hematoma of a respiratory system organ or structure following other procedure
• J95.862, Postprocedural seroma of a respiratory system organ or structure following a respiratory system procedure
• J95.863, Postprocedural seroma of a respiratory system organ or structure following other procedure.

Relearn mediastinitis: Mediastinitis codes have undergone a big overhaul with an increased focus on specificity. We have two new diagnosis options to implement in October:

• J98.51 (Mediastinitis) with an addition of the phrase “Code first underlying condition, if applicable, such as postoperative mediastinitis (T81.-)”
• J98.59 (Other diseases of mediastinum, not elsewhere classified) with addition of term such as 

        o Fibrosis of mediastinum
        o Hernia of mediastinum
        o Retraction of mediastinum

Note: The terms fibrosis/hernia/retraction of mediastinum, mediastinitis have been deleted from the extended description of J98.5 (Diseases of mediastinum, not elsewhere classified).

Given such a major overhaul of codes, it is important that “both physicians along with their coders and work together to review, update and incorporate the new codes into the practice billing software,” says Berman.

Final takeaway: “As we prepared for ICD-10 implementation, ICD-10 coding changes were placed on a freeze,” says Pohlig. “Now that ICD-10 has been fully implemented, we need to be aware of the coding changes that will resume. Remember to review any existing coding tools in your practice that will be affected by these changes, and notify the providers and staff that are involved in code selection billing, pre-certification or pre-authorizations who need to be aware of these changes. Accurate diagnosis code reporting requires an understanding of any revisions or additions/deletions that take place. Payment can be affected if payers update their policies reflecting the code changes, and your practice does not. Make sure you are prepared.”