Pulmonology Coding Alert

Postprocedural complications and mediastinitis add up to the J codes.

Are you unnerved with the news of 1,900 new ICD-10-CM codes and over 3,000 new PCS codes being added to the ICD-10-CM codeset, as per the annual update due to be implemented in October for FY 2017? The good news for you is that the J codes belonging to the pulmonology section apparently did not see too many additions.

“Specificity is always the goal of documentation and ICD-10 coding,” says Carol Pohlig, BSN, RN, CPC, ACS, senior coding and education specialist at the Hospital of the University of Pennsylvania. “Being aware of code changes helps changing certain documentation habits.”

You do need to get a complete picture, taking note of the code revisions as well. Read on to know more.

Category J95.8 Gets Separate Codes for Post Procedural Hemorrhage and Hematoma

The need for a new code probably stemmed for specific requirement of coding for a hematoma only, regardless of a hemorrhage. Category J95.8~ (Other intraoperative and postprocedural complications and disorders of respiratory system, not elsewhere classified) is used to report complications related to the pulmonary system during or after a procedure. Until now this category had codes for postprocedural pneumothorax (J95.81), postprocedural respiratory failure (J95.82~), postprocedural hemorrhage and hematoma (J95.83~), transfusion lung injury (J95.4~), ventilator complications (J95.85~), other intraoperative complications (J95.8), and other post procedural complications (J95.89~). Now we have two new choices, effective from Oct.1, 2016:

• J95.860 (Postprocedural hematoma of a respiratory system organ or structure following a respiratory system procedure)
• J95.861 (Postprocedural hematoma of a respiratory system organ or structure following other procedure).

J95.83~ revised: In the 2015 codeset, the J95.83~ codes included reporting of both hemorrhage and hematoma. However, beginning Oct. 1, 2016, the J95.83~ codes have been revised to report only hemorrhage, as depicted in the table.

For inpatient billing and DRG classification, both of the new diagnosis codes can be considered as a CC, or a comorbidity, and can be included in the DRGs 919 (Complications of treatment W MCC), 920 (Complications of treatment W CC), and 921 (Complications of treatment W/O CC/MCC).

Mediastinum Coding Gets More Precise

In the past, category J98 (Other respiratory disorders) had a solitary code J98.5 (Diseases of mediastinum, not elsewhere classified), which included conditions such as mediastinitis, fibrosis, hernia, and retraction. Now, we have two fifth character additions, thereby segregating mediastinitis from other diseases of mediastinum:

• J98.51 (Mediastinitis)
• J98.59 (Other diseases of mediastinum, not elsewhere classified).

The update mentions that these pathologies, if present in an inpatient, must be looked upon as MCC. The associated MS DRGs will be 177 (Respiratory infections and inflammations W MCC), 178 (Respiratory infections and inflammations W CC), 179 (Respiratory infections and inflammations W/O CC MCC), and 793 (Full term neonate W major problems).

Remember: The coding guidelines for the above new codes will stay the same, but remember that the pulmonologist will be responsible for proper documentation, keeping in mind the payer’s perspective.

“When conditions are specified in their own code, it usually requires a more detailed level of documentation,” says Pohlig. “Improving documentation helps to prevent queries from coders or CDI personnel, and better depicts patient acuity.”