Pulmonology Coding Alert

Watch out for descriptor changes to codes in ICD-10.

If your pulmonologist arrives at a diagnosis of viral pneumonia after Oct.1, 2014, you’ll need to continue to concentrate on the causative viral organism as in ICD-9 – look for broader reporting options in ICD-10 and focus on more comprehensive list of exclusions while reporting.

Use Etiology to Identify Correct ICD-9 Code

When your pulmonologist arrives at a diagnosis of pneumonia due to viral pneumonia, you need to report the diagnosis with 480 (Viral pneumonia). Depending on the viral etiology, 480 further expands into the following six codes:

480.0 (Pneumonia due to adenovirus)

480.1 (Pneumonia due to respiratory syncytial virus)

480.2 (Pneumonia due to parainfluenza virus)

480.3 (Pneumonia due to SARS-associated coronavirus)

480.8 (Pneumonia due to other virus not elsewhere classified)

480.9 (Viral pneumonia unspecified)

However, this ICD-9 code does not cover pneumonia caused due to allergy, aspiration, congenital, lipoid, passive, rheumatic, and ventilator associated pneumonias and they have to be reported using appropriate ICD-9 codes.

Observe Comprehensive Exclusion and Descriptor Changes in ICD-10

When ICD-10 codes come into effect, 480 in ICD-9 codes crosswalks to J12(Viral pneumonia, not elsewhere classified) code family in ICD-10. This code in ICD-10 also includes bronchopneumonia due to viruses other than influenza viruses.

ICD-10 coding guidelines for J12 specify that any associated influenza (J09.X1, J10.0-, J11.0-) or associated abscess (J85.1) should be coded first if it is present with viral pneumonia. The exclusions to J13 are similar to the exclusions to 481 in ICD-9. However, the exclusions list is more comprehensive and comprises aspiration pneumonia that may occur during pregnancy (O29), labor or delivery (O74.0) and during puerperium (O89.0) along with congenital rubella pneumonitis (P35.0) and interstitial pneumonia NOS (J84.9).

As in ICD-9, depending on etiology, J12 further expands into the following codes:

J12.0 (Adenoviral pneumonia)

J12.1 (Respiratory syncytial virus pneumonia)

J12.2 (Parainfluenza virus pneumonia)

J12.3 (Human metapneumovirus pneumonia)

J12.8 (Other viral pneumonia)

J12.9 (Viral pneumonia, unspecified)

Note: In ICD-10, you have a separate code for viral pneumonia due to human metapneumovirus that is not in ICD-9. Also, J12.8 further expands using a 5^th digit into J12.81 (Pneumonia due to SARS-associated coronavirus) and J12.89 (Other viral pneumonia).

Reminder: "Do not report a diagnosis identifying a particular organism unless you have documented proof of the cause," reminds Carol Pohlig, BSN, RN, CPC, ACS, senior coding and education specialist at the University of Pennsylvania, Department of Medicine in Philadelphia. "For physician claims, you can only report the diagnosis available at the time of service. If the pathology is not confirmed until day 2 of the hospitalization, you can only report the "unspecified" code (J12.9) on day 1."

Study These Clues in Documentation

Look for symptoms such as fever with chills (R50.9, Fever, unspecified); non-productive cough (R05, Cough); headache (R51, Headache); rhinitis; fatigue (R53.83, Other fatigue); malaise (R53.81, Other malaise)and generalized pain (R52).

Upon examination, your pulmonologist might record rhonchi or rales along with presence of wheezing. Your pulmonologist might also note dullness upon percussion and reduction in breath sounds upon auscultation.

Your pulmonologist might also collect a nasal swab sample which will be subject to testing using Rapid antigen detection kits (for detection of virus). If he needs further confirmation on the viral etiology, he might resort to performing a bronchioalveolar lavage or a biopsy sample might be taken and the sample might be used to grow the virus in a culture medium.

He may also draw a blood from an artery in the wrist to check for arterial blood gases to ascertain the efficiency of exchange of blood gases. Your pulmonologist will also order a chest x-ray to ascertain the reason for the symptoms the patient is experiencing and to know the cause for the altered breath sounds.

Review This Example

A 63-year-old female patient presents to your pulmonologist with complaints of severe non-productive cough. She also complains of fever with chills, shortness of breath and generalized malaise and fatigue. Your pulmonologist performs a thorough history taking and examination of the patient. Upon auscultation, your pulmonologist notes dull breath sounds and dull percussion note. He also notes the presence of wheezing.

Your pulmonologist collects a nasal swab sample, withdraws an arterial blood sample and sends it over to the lab for viral detection using rapid antigen detection kits and PCR (polymerase chain reaction). He also orders a chest x-ray. Your pulmonologist also performs a bronchoalveolar lavage and sends over the collected fluid to the lab for culture. The lab results confirm a diagnosis of pneumonia due to parainfluenza virus.

What to report: You will have to report the diagnosis using J12.2 if you’re using ICD-10 and 480.2 if you’re using ICD-9 codes. Don’t forget to report the bronchoalveolar lavage that your pulmonologist performed using 31624 (Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed with bronchial alveolar lavage).

Be sure to scrutinize the physician’s documentation. "If the physician merely states "rule out parainfluenza pneumonia", you cannot report J12.2 since the pathology has not been confirmed," says Pohlig.