Pulmonology Coding Alert

Hint: Don’t report newborn atelectasis or tuberculous atelectasis using J98.11.

When reporting a diagnosis of atelectasis using ICD-10 codes, you’ll turn to a specific code to report the condition unlike ICD-9 which limits you to a general catchall category for pulmonary collapse.

ICD-9:You report a diagnosis of atelectasis with 518.0 (Pulmonary collapse).

Reminder: Since 518.0 is an ICD-9 code for pulmonary collapse, you can use the same diagnosis code when your pulmonologist makes a diagnosis of collapse of lung or middle lobe syndrome. However, you cannot use 518.0 if the diagnosis is primary atelectasis (770.4), partial congenital atelectasis (770.5) or tuberculous atelectasis (011.8).

Differentiate From Other Forms of Pulmonary Collapse in ICD-10

When ICD-10 system of codes comes into effect, the ICD-9 code 518.0, used to report a diagnosis of atelectasis, crosswalks to J98.11 (Atelectasis). However, as in ICD-9 codes, you cannot use J98.11 if the diagnosis is atelectasis of the newborn or tuberculous atelectasis (A15).

You’ll have to note that unlike in ICD-9, you have a very specific ICD-10 code for atelectasis. This will help you differentiate atelectasis from other forms of pulmonary collapse. If the pulmonary collapse has occurred due to any other conditions such as a middle lobe syndrome, you’ll have to report it with J98.19 (Other pulmonary collapse).

Focus on These Basics Briefly

Documentation spotlight: When your pulmonologist arrives at a diagnosis of atelectasis, some of the signs and symptoms that you are more likely to find in the patient documentation will include dyspnea of sudden onset, pain in the area of collapse, malaise and shock.

Upon examination, your pulmonologist might note cyanosis, tenderness of the affected area, tachycardia and hypotension. Your pulmonologist might also observe reduction of chest excursion and in some cases, total absence of chest excursion in the affected side. Your pulmonologist might also see a deviation of the trachea to the side that is collapsed due to the atelectasis. Upon auscultation, your pulmonologist might note the absence of breath sounds and dullness of the affected area during percussion.

Tests: If your pulmonologist suspects a diagnosis of atelectasis, he will order imaging studies such as chest x-ray or a CT scan. The imaging studies will help your pulmonologist by showing signs of collapse that will help arrive at a diagnosis of atelectasis.

In addition to imaging studies, your pulmonologist will also ask for arterial blood gas determination to assess PaO₂ and PaCO₂ levels. You’ll notice high levels of PaCO₂ levels which will help confirm the diagnosis of atelectasis.

 Your pulmonologist might also perform invasive studies such as a bronchoscopy with lavage to help determine the cause for the pulmonary collapse. He might also ask for histologic studies of the lavage sample to determine if aspergillus infection is causing any obstructions or if there is any malignant cause.

Example: Your pulmonologist reviews a 53-year-old male patient who suddenly developed dyspnea and pain on the right side of his chest. The patient also mentioned that he had suffered from an upper respiratory infection in the past week or so but he did not have any trouble breathing till the previous night. He also mentioned that he has been having chills and fever from the previous night.

Upon examination, your pulmonologist notes the presence of cyanosis of the extremities along with tachycardia and drop in blood pressure to 105/75mm of Hg. Specific examination of the respiratory system reveals deviation of the trachea to the right and tenderness of the right side of the chest. He also notes reduced chest excursion on the right side.

Your pulmonologist notes dullness of the right side upon percussion and absence of breath sounds upon auscultation while the left side appears to have no abnormalities upon percussion and auscultation.

Suspecting pulmonary collapse, your pulmonologist withdraws an arterial blood sample that he sends to the lab for analysis of blood gases. He also orders for a chest x-ray. Based on the observations of the chest x-ray and lab tests, your pulmonologist confirms a diagnosis of atelectasis.

He performs a bronchoscopy and during the procedure notes obstruction of the lobar bronchus due to mucosal plugs. He performs a lavage by instilling saline and suctioning it. He then sends the suctioned sample for histological studies.

What to report: You report the evaluation of the patient with 99223 (Initial hospital care, per day, for the evaluation and management of a patient, which requires these 3 key components…). You will report the lavage that your pulmonologist performed using 31624 (Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with bronchial alveolar lavage). You will report the diagnosis of atelectasis with J98.11 if you’re using ICD-10 codes or report 518.0 if you’re using ICD-9 codes.