Acute pulmonary edema
Chronic pulmonary edema
Coding Tip:
The descriptors to unspecified pulmonary edema in the ICD-10 system will become more simplified and straightforward enabling you to choose the apt code eliminating any kind of confusion that was more likely when you had to choose a code using the ICD-9 code sets.
Check on These Specifics in Documentation
When your pulmonologist notes a diagnosis of unspecified pulmonary edema, some of the symptoms that you are more likely to come across in the documentation of the patient will include dyspnea (R06.00,
Dyspnea, unspecified); tachypnea (R06.82, Tachypnea, not elsewhere classified); wheezing (R06.2, Wheezing); pallor (R23.1 Pallor); weakness (R53.1, Weakness) and excessive sweating (R61, Generalized hyperhidrosis).
Your pulmonologist will record a thorough medical history of the patient and will perform a thorough physical examination. He might note crackles or rales heard upon auscultation. If your pulmonologist suspects a diagnosis of pulmonary edema, he will order for a chest x-ray and will order for an electrocardiogram to rule out a heart condition causing the edema. A blood sample will usually be drawn to check BNP levels, CBC and to undertake kidney function tests. An arterial blood sample will also be taken by your pulmonologist to check arterial blood gases to know the levels of carbon dioxide and oxygen.
To check wedge pressure in the pulmonary artery, your pulmonologist might pass a Swan-Ganz catheter into the pulmonary artery. This procedure will help in identifying whether the edema is due to a cardiac cause or due to some other cause.
Based on results of the above mentioned tests and x-rays, if your pulmonologist rules out a cardiac cause for the
pulmonary edema, you will have to report the diagnosis as unspecified pulmonary edema of the lung.
Example:
Your pulmonologist assesses a 61-year-old male patient for complaints of severe dyspnea and tachypnea. The patient also complains of increasing incidence of weakness and wheezing.
Your pulmonologist performs a thorough recording of the patient's history and then proceeds to perform a thorough examination of the patient. He observes skin pallor in the documentation and notes crackling sounds heard on auscultation.
He orders for a chest x-ray and withdraws an arterial and venous blood sample and sends it to the lab for arterial blood gases, CBC and to check BNP levels. He also undertakes pulmonary artery catheterization using a Swan-Ganz catheter to check if there is a cardiac cause for the symptoms the patient is experiencing. He records a wedge pressure less than 18mmHg thus ruling out a cardiac cause for edema. The BNP levels of less than 100 further confirms that the patient has no cardiac condition that is inducing pulmonary edema.
Coding:
You report the evaluation of the patient with 99222 (Initial hospital care, per day, for the evaluation and management of a patient, which requires these 3 key components...), 93503 (Insertion and placement of flow directed catheter [e.g., Swan-Ganz] for monitoring purposes) for the pulmonary artery catheterization and report the diagnosis with J81.0 if you are using ICD-10 and 518.4 if you are using ICD-9 codes.