Pulmonology Coding Alert

Hint: Don’t forget to code the inhaled substance separately with an appropriate T code.

When your pulmonologist diagnoses pneumonitis due to the inhalation of any solids or liquids, you’ll select an ICD-10 code based on the type of solids or liquids inhaled as you’ve been doing under ICD-9.

ICD-9: You currently base a pneumonitis diagnosis on the type of solid or liquid that is inhaled, choosing from three codes:

• 507.0 — Pneumonitis due to inhalation of food or vomitus
• 507.1 — Pneumonitis due to inhalation of oils and essences
• 507.8 — Pneumonitis due to other solids and liquids

Exclusions: You cannot report 507.x if the diagnosis is fetal aspiration pneumonitis (770.18); post procedural pneumonitis (997.32); or endogenous lipoid pneumonia (516.8).

ICD-10: When you begin using ICD-10 coding system instead of ICD-9 code sets, 507 in ICD-9 crosswalks to J69 (Pneumonitis due to solids and liquids). Again, as in ICD-9, depending on the type of solids or liquids ingested, you have three code choices to report this diagnosis:

• J69.0 — Pneumonitis due to inhalation of food and vomit
• J69.1 — Pneumonitis due to inhalation of oils and essences
• J69.8 — Pneumonitis due to inhalation of other solids and liquids

Exclusions: As in ICD-9, you cannot report J69.x if your pulmonologist arrives at a diagnosis of neonatal aspiration syndromes (P24.-); post procedural pneumonitis (J95.4) or endogenous lipoid pneumonia (J84.09). In addition, J69.x cannot be used if the diagnosis is chemical pneumonitis due to anesthesia (J95.4) or obstetric aspiration pneumonitis (O74.0).

Check These Basics Briefly

Documentation spotlight: Your pulmonologist will arrive at a diagnosis of pneumonitis due to solids or liquids based on a thorough history, medical examination, signs and symptoms and the findings of blood tests and diagnostic tests such as pulmonary function tests and chest x-rays.

Some of the signs and symptoms that you are more likely to encounter in the documentation of a patient diagnosed with pneumonitis due to solids or liquids will include fever, cough, malaise, shortness of breath, pain during breathing, weight loss and fatigue.

Tests: A history of inhalation of any solid or liquid will point your pulmonologist in the direction of pneumonitis. To arrive at a definitive diagnosis of pneumonitis due to solids or liquids, your pulmonologist will have to undertake further tests and diagnostic procedures to confirm the condition. Your pulmonologist might order certain lab tests such as blood count (CBC) and certain immune assays to rule out hypersensitivity pneumonitis.

Your pulmonologist will also use the aid of chest x-rays and perform certain diagnostic tests such as bronchoscopy with lavage or bronchoscopy with biopsy. Your physician will also rely on pulmonary function tests such as spirometry and pulse oximetry to help confirm the diagnosis of pneumonitis.

Example: A pulmonologist recently reviewed a seven-year-old boy for severe shortness of breath following suspected ingestion of an aromatic bath oil. The boy’s mother informed our pulmonologist that she found the child in the bathroom coughing and gasping for breath with an opened bottle of the bath oil on the floor following which she called 911.

Upon examination, your pulmonologist notes the presence of cyanosis of the extremities along with tachycardia and drop in blood pressure. Based on history and observation of signs and symptoms, our pulmonologist suspecting pneumonitis decides to perform a bronchoscopy with lavage and he sent the lavage sample to the lab for analysis. He also withdraws a blood sample to be sent to the lab for CBC and white blood cell counts.

He also orders for a chest x-ray and performs pulse oximetry. Based on the history, findings on physical examination and results of imaging studies, lab studies, and bronchoscopy, your pulmonologist confirms a diagnosis of pneumonitis caused to the inhalation of the aromatic bath oil.

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 pneumonitis due to the inhalation of the oil with J69.1 if you’re using ICD-10 codes or report 507.1 if you’re using ICD-9 codes.