Pulmonology Coding Alert

Good news: You no longer need separate diagnosis codes for known and idiopathic causes.

When your pulmonologist diagnoses lymphoid interstitial pneumonia, you will be pleased to know that you can capture this with a very specific code in ICD-10 code sets and not resort to a more generalized code as you had to do when capturing this diagnosis with the ICD-9 coding system.

ICD-9: When your pulmonologist diagnoses lymphoid interstitial pneumonia, you’ll have to report it with either 516.8 (Other specified alveolar and parietoalveolar pneumonopathies) or 516.35 (Idiopathic lymphoid interstitial pneumonia) when you are using ICD-9 codes. If the underlying cause for the lymphoid interstitial pneumonia is identified, then you’ll have to use 516.8 along with the code that represents the underlying cause; and if it is due to idiopathic cause, you’ll have to report 516.35.

Note: Apart from using the ICD-9 code 516.8 for lymphoid interstitial pneumonia due to known underlying cause and lymphoid interstitial pneumonia NOS, you can also use the same ICD-9 code for a diagnosis of other conditions such as endogenous lipoid pneumonia, interstitial pneumonia, non-specific interstitial pneumonia due to known underlying cause, non-specific interstitial pneumonia NOS, organizing pneumonia due to known underlying cause, and organizing pneumonia NOS.

ICD-10: When you begin using ICD-10 codes, a diagnosis of lymphoid interstitial pneumonia that you report with either 516.8 or 516.35 using ICD-9 codes will crosswalk to J84.2 (Lymphoid interstitial pneumonia). You also use the same ICD-10 code if your pulmonologist’s diagnosis is lymphoid interstitial pneumonitis.

Focus on these Basics Briefly

Documentation Spotlight: Your pulmonologist will arrive at a diagnosis of lymphoid interstitial pneumonia based on a thorough history, medical examination, signs and symptoms and based on the findings of blood tests and diagnostic tests such as pulmonary function tests, bronchoscopy and chest x-rays.

Some of the common symptoms that you will encounter in a patient with lymphoid interstitial pneumonia will include fever, chronic cough and dyspnea. The patient might also complain of dryness of the eyes and mouth. Upon examination, your pulmonologist might note the presence of generalized lymph node enlargement, hepatosplenomegaly, enlargement of the parotid glands, and respiratory manifestations such as rales or wheezing.

Tests: Your pulmonologist might draw an arterial blood sample to check arterial blood gases. This may help your clinician assess the patient’s condition and disease progress. He might also ask for pulmonary function tests to assess diffusion capacity and to check for presence of obstruction.

Imaging studies such as a chest x-ray will help your pulmonologist clinch the diagnosis of the condition. Apart from ordering a chest x-ray, your clinician might also ask for a CT study to know the severity of the condition and to check for other chronic conditions that might co-exist.

Your pulmonologist might also opt to perform a bronchoscopy and obtain transbronchial biopsy samples to help confirm a diagnosis of lymphoid interstitial pneumonia. If there is extensive fibrosis present, your clinician might want to perform a biopsy of the lung.

Although other lab tests are not very specific in the diagnosis of the condition, your clinician might ask for tests for HIV, rheumatoid factor, and Epstein Barr virus to assess the etiology of the condition.

Example: A 59-year-old male patient arrives at your pulmonologist’s office with complaints of increasing dyspnea, chronic cough and presence of fever from the past three days. Your pulmonologist performs a thorough evaluation with a thorough recording of the patient’s history.

Upon examination, your clinician notes parotid enlargement, hepatosplenomegaly and presence of lymphadenopathy. During examination, your pulmonologist notes the presence of rales but no signs of wheezing are present.

Your pulmononologist orders for a chest x-ray and pulmonary function tests to check for diffusing capacity and determination of lung volumes. Your pulmonologist notes presence of honey comb appearance and suspects a diagnosis of interstitial pneumonia. He orders for serological tests for HIV, EBV and rheumatoid factor and the results arrive negative for all these conditions.

He performs a bronchoscopy and also obtains transbronchial biopsy samples from various sites. The biopsied samples are sent to the lab for histological studies. Based on observations from the bronchoscopy, the results from the histological studies and from the interpretations of the chest x-ray, your pulmonologist is able to confirm a diagnosis of idiopathic lymphoid interstitial pneumonia.

What to report: If the patient’s respiratory status is compromised requiring hospitalization, you report the evaluation and management of the patient with E/M codes 99222 (with modifier 25 if the procedure is performed on the same day). You report the bronchial biopsy procedure with 31628 (Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with transbronchial lung biopsy[s], single lobe) and 31632 (Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with transbronchial lung biopsy[s], each additional lobe [List separately in addition to code for primary procedure]), but only if a second lobe is biopsied.

You report the PFT studies with 94727-26 (Gas dilution or washout for determination of lung volumes and, when performed, distribution of ventilation and closing volumes) and +94729-26 (Diffusing capacity [e.g., carbon monoxide, membrane] [list separately in addition to code for primary procedure]).

You report 516.35 if you are reporting the diagnosis using ICD-9 codes or report J84.2 if you’re using ICD-10 system of codes.