Pulmonology Coding Alert

Use history and symptoms hand-in-hand to arrive at the right diagnosis.

Currently, if your pulmonologist arrives at the diagnosis of farmer's lung, you need to report it with the ICD-9 code 495.0 (Farmers' lung). When ICD-9 transforms to ICD-10 effective October 1, 2013, the ICD-10 code for farmers' lung will change to J67.0 (Farmer's lung). However, the descriptor under ICD-10 will remain the same as in ICD-9. Read on for more on the condition and how to report it.

Clinical details: Hypersensitivity pneumonitis is also termed as extrinsic allergic alveolitis (EAA). EAA is a respiratory condition caused by a hypersensitivity reaction to inhaled extrinsic factors resulting in inflammation in the alveoli of the lungs. This is an occupational hazard, and the classification of EAA is also done on the basis of the inhaled extrinsic factor.

One such type of EAA is Farmer's lung. Farmer's lung is caused by inhalation of moldy hay particles or other agricultural dust particles contaminated by mold.

"The inhalation of these particles will initially demonstrate type III hypersensitivity (immune-complex induced tissue injury) which results in inflammation of the alveoli. If left unchecked or exposure continually persists, it will lead to a chronic inflammatory condition," says Carol Pohlig, BSN, RN, CPC, ACS, senior coding and education specialist at the University of Pennsylvania Department of Medicine in Philadelphia.

ICD difference: Although ICD-10 codes are aimed at improving the description of the diagnosis of diseases based on advancements in medical science, the descriptor for Farmers' lung remains unaffected under J67.0.

Coding tips: Documentation of the signs and symptoms forms an integral part of the report when your pulmonologist considers the differential diagnoses of any type of EAA.

Some of the commonly seen signs and symptoms that need to be reported and that you should look for in the note will include: fever (R50.9, Fever unspecified), fatigue (R53.83, Other fatigue), shortness of breath (R06.02, Shortness of breath), painful breathing (R07.1, Chest pain on breathing), anorexia (R63.0 and weight loss (R63.4, Abnormal weight loss).

But, to arrive at a definitive diagnosis of farmers' lung (or any other type of EAA), your pulmonologist will need a full fledged history, a thorough examination and the results of diagnostic tests, such as bronchoscopy (31622 [Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; diagnostic, with cell washing, when performed (separate procedure)], 31623 [....with brushing or protected brushings], 31624 [.....with bronchial alveolar lavage], 31628 [.... with transbronchial lung biopsy(s), single lobe]) and pulmonary function tests (94010 [Spirometry, including graphic record, total and timed vital capacity, expiratory flow rate measurement(s), with or without maximal voluntary ventilation], 94727 [Gas dilution or washout for determination of lung volumes and, when performed, distribution of ventilation and closing volumes], 94375 [Respiratory flow volume loop], +94729 [Diffusing capacity (e.g., carbon monoxide, membrane)(List separately in addition to code for primary procedure)]).