Pulmonology Coding Alert

Hint: Look for other expansions to J66 for pneumopathy due to inhalation of other dusts.

When your pulmonologist diagnoses byssinosis, a condition caused by inhalation of cotton dust, you’ll be pleased to know that you have a very specific code to report this condition with ICD-10 codes, a choice that you did not have while using ICD-9.

ICD-9: When reporting a diagnosis of byssinosis in ICD-9, you’ll have to report it with 504 (Pneumonopathy due to inhalation of other dust). You’ll have to report the same diagnosis code for inhalation of other dust particles like cannabis (cannabinosis) or unprocessed flax (flax dressers’ disease).

Caveat: You cannot use 504 for a diagnosis of allergic alveolitis (495.0-495.9); bagassosis (495.1); asbestosis (501); and farmer’s lung (495.0) as these have other specific ICD-9 codes that you can report when your clinician diagnoses these conditions.

ICD-10: When you begin using ICD-10 codes, 504 that you use to report a diagnosis of pneumopathy due to inhalation of other dusts crosswalks to category J66 (Airway disease due to specific organic dust).

As in ICD-9, the list of exclusions is similar and comprises allergic alveolitis (J67.-); asbestosis (J61); bagassosis (J67.1); farmer’s lung (J67.0); hypersensitivity pneumonitis due to organic dusts (J67.-) and reactive airways dysfunction syndrome (J68.3).

However, unlike in ICD-9 where you have a more general code that includes byssinosis, cannabinosis and flax-dressers’ disease, in ICD-10, you have more specific codes to report these diagnoses separately. J66 expands into the following four codes so that you can report these diagnoses appropriately based on the type of dust that is inhaled:

• J66.0 (Byssinosis)
• J66.1 (Flax-dressers’ disease)
• J66.2 (Cannabinosis)
• J66.8 (Airway disease due to other specific organic dusts)

So, when your pulmonologist arrives at a diagnosis of byssinosis, you can report this diagnosis with J66.0. By looking at the ICD-10 code, you can ascertain what type of dust has caused the pneumopathy while this cannot be done when you report 504 using ICD-9 codes.

Focus on These Basics Briefly

Documentation spotlight: Your pulmonologist will arrive at a diagnosis of byssinosis 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, CT scans and chest x-rays.

The history of working with cotton dust will make your pulmonologist suspect a diagnosis of byssinosis. Some of the signs and symptoms that your pulmonologist might note in a patient suffering from byssinosis might include symptoms similar to that seen in asthma. So, the patient is more likely to present symptoms such as wheezing, coughing, difficulties with breathing and tightness of the chest area.

Tests: Based on history, signs and symptoms and physical findings, if your pulmonologist suspects a diagnosis of byssinosis your clinician will order for imaging tests such as a chest x-ray or a CT scan to ascertain the diagnosis. He might also opt to obtain an arterial blood sample to check for arterial blood gases to see if there is any reduction in oxygen saturation.

Your pulmonologist might also depend on pulmonary function tests such as spirometry (94010, Spirometry, including graphic record, total and timed vital capacity, expiratory flow rate measurement[s], with or without maximal voluntary ventilation), determination of lung volumes (94727, Gas dilution or washout for determination of lung volumes and, when performed, distribution of ventilation and closing volumes) and respiratory flow volume (94375, Respiratory flow volume loop) to support the diagnosis of byssinosis.

Example: A 47-year-old male patient arrives at your pulmonologist’s office with complaints of breathing difficulties and tightness of the chest area. He complains that he has been having these symptoms for quite sometime now and of late the symptoms have increased and has been affecting his work and day-to-day life. He also mentions that he seems to be having these symptoms more during the start of the week and then it seems to stabilize for some 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 15 years now. 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. Your pulmonologist withdraws an arterial blood sample and sends it to the lab to check for arterial blood gases. Your clinician also orders for a chest x-ray.

He performs pulmonary function tests like spirometry, respiratory flow volume and determination of lung volumes.

Based on history, signs and symptoms, results of lab tests, imaging tests and pulmonary function tests, your clinician is able to confirm a diagnosis of byssinosis.

What to report: You report the evaluation of the patient with 99203 (Office or other outpatient visit for the evaluation and management of a new patient…). You report the pulmonary function tests with 94010 and 94727. According to Correct Coding Initiative (CCI) edits, the CPT® code 94375 is bundled into 94010 with the modifier indicator ‘0,’ which means that you cannot report these two codes for the same session together. For this reason, you will only report 94010 and 94727 for the PFTs and not report 94375.

You report the diagnosis of byssinosis with J66.0 if you are using ICD-10 codes or report 504 if you are using the ICD-9 coding system.