Pulmonology Coding Alert

Don’t forget to take into account the number of conditions the code will represent.

When you’re reporting a diagnosis of acute laryngitis after Oct.1, 2014, don’t forget to take into account the presence or absence of obstruction -- even though descriptor changes in ICD-10 don’t mention obstruction (as in ICD-9), you have two different code sets to take into account.

Assign One Code for Several Types of Acute Laryngitis

Diagnosis coding is simple in ICD-9 when your pulmonologist diagnoses acute laryngitis: If no obstruction is present, you assign 464.00 (Acute laryngitis; without mention of obstruction). The code applies to patients with several types of laryngitis, provided they don’t experience blockages of the passageway:

• Edematous laryngitis
• Hemophilus influenzae laryngitis
• Pneumococcal laryngitis
• Septic laryngitis
• Suppurative laryngitis
• Ulcerative laryngitis.

The code also applies to acute laryngitis not otherwise specified.

Look for Obstruction in ICD-10

Once ICD-10 goes into effect, you’ll use code J04.0 (Acute laryngitis) to report acute laryngitis without obstruction. ICD-10 has a broader description of acute laryngitis that doesn’t include the explanatory phrase "without obstruction" in the descriptor. Also, ICD-10 asks you to report an additional code (B95-B97) to identify the infectious agent responsible for the acute laryngitis, if possible.

Remember, until a test confirms a condition, you should use signs-and-symptoms diagnoses rather than the diagnosis code for the condition itself. Look to your physician’s documentation to guide your code selection.

Reminder: Even though descriptor doesn’t mention obstruction, you will have to look through documentation for presence of obstruction. If obstruction is present, you will have to look at J05.0 (Acute obstructive laryngitis [croup]) instead of J04.0.

Coding tip: If the patient follows a treatment plan, he or she should have a quick recovery from acute laryngitis. If the patient’s symptoms have not resolved after approximately 3 weeks, however, the physician should evaluate the patient for chronic laryngitis. You currently code chronic laryngitis as 476.0, and will switch to J37.0 (Chronic laryngitis) under ICD-10.

Example: Your pulmonologist assesses a patient presenting with symptoms of cough, sore throat and hoarseness of voice. The patient complains that he has been suffering from these symptoms from the past one week and has now developed severe symptoms of rhinitis and has been having fever for the past two days.

Your pulmonologist records the patient’s history and performs a thorough examination of the patient. He then performs a direct examination of the larynx using a laryngoscope and observes edema in the vocal folds. He mentions that there is no obstruction of the airways present.

Based on history, examination, and findings during laryngoscopy, your pulmonologist arrives at the diagnosis of acute laryngitis without obstruction. You report the diagnosis with J04.0 using ICD-10 and 464.00 if you are using ICD-9 code sets.