Pulmonology Coding Alert

Recurrence of disease will be a major factor in deciding the code.

When ICD-9 becomes ICD-10 in 2015, you may not have to worry much about the possible expansion of codes in sinusitis reporting as there is almost none. Sinusitis coding has a one-to-one walkover for almost all the ICD-9 codes.

Background: Sinusitis is caused by the inflammation, or swelling, of the tissue lining the sinuses (air-filled spaces in the skull located behind the forehead, nasal bones, cheeks, and eyes). Healthy sinuses allow free flow of air through them and mucus is able to drain out, but when they become blocked and filled with fluid, germs (bacteria, viruses, and fungi) can grow and cause an infection. Check out these common sinusitis diagnoses, and discover what you’ll report after October 1, 2015.

Currently, when your physician treats a patient for sinusitis, you report the appropriate sinusitis code for sinus membrane lining inflammation. You currently assign 461.x for acute sinusitis cases and 473.x for chronic sinusitis.

Location Dictates the Code Expansion

Location of infection determines the fourth digit in ICD-9 for both acute and chronic conditions and there are six possible fourth digit expansion codes. For example, for ethmoidal chronic sinusitis, you report (473.2, Chronic sinusitis; ethmoidal).

ICD-10 difference: Location remains the major criterion next year onward too in ICD-10 and the good news is that sinusitis options have a one-to-one match with upcoming ICD-10 codes. For acute sinusitis diagnoses, you’ll have to visit the J01.-- subsection. So, 461.0 (Acute maxillary sinusitis) translates to J01.00 (Acute maxillary sinusitis, unspecified). Code 461.1 (Acute frontal sinusitis) maps directly to J01.10 (Acute frontal sinusitis, unspecified). Notice how the definitions are mostly identical. Like ICD-9, the fourth digit changes to specify location.

For chronic sinusitis diagnoses, you’ll look to the J32.- codes. For instance, in the example above, 473.2 maps direction to J32.2 (Chronic ethmoidal sinusitis). Again, this is a direct one-to-one ratio with identical definitions. Like ICD-9, the fourth digit changes to specify location. The possible fourth digit can be 0-3 and 8-9 depending upon the location and specificity, same as in ICD-9 system.  

Recurrence of Sinusitis Adds New Dimension to Coding

Other than the location of sinusitis, ICD-10 introduces a new coding specificity. You will use the fifth digit 0 or 1 after the ICD-10 transition takes place, to specify whether the sinusitis is recurrent or not. You will denote recurrence with 1 and non-recurrent sinusitis with 0. For instance, with ICD-9 you would report 461.2 for any acute ethmoidal sinusitis, but with ICD-10 you will have to confirm whether the ethmoidal sinusitis is recurrent (J01.21) or not (J01.20). The other codes in the acute sinusitis category follow this lead as well.

Note: ICD-10 offers additional specific codes to identify pansinusitis (J01.4x), whereas with ICD-9, that falls under the “other acute sinusitis” code 461.8.

Documentation: The biggest documentation adjustment will be that the physician must record whether the patient’s sinusitis is recurrent or not, because your fifth digit code choice will hinge on that factor.