Remember a 4th character for ICD-10-CM codes.
Bronchiectasis is a respiratory condition where the patient’s bronchi become damaged and widen. Since the damaged bronchi cannot clear mucus efficiently, bacteria begin to grow in the mucus, causing the body structure to become inflamed and damaging the lungs. As a pulmonology coder, you’ll want to be aware of the condition.
Get to know the condition, procedures, and diagnosis codes you’ll need to complete your claim.
Define the Bronchiectasis Types and Related Conditions
Airway damage caused by bronchiectasis falls into cylindrical (tubular), varicose, and cystic types. Cylindrical is considered the least severe and cystic is the most severe form. Pulmonologists also categorize bronchiectasis by where the condition is located in the lungs — focal if the condition develops in one area and diffuse if it occurs in multiple areas. Another type of bronchiectasis is traction bronchiectasis, which occurs when scarring in the lungs pulls the patient’s airways out of shape.
Patients can experience several symptoms when suffering from bronchiectasis, including:
At times, the patient may experience symptoms that are less severe or more severe with flare-up (exacerbation). Exacerbation symptoms include fatigue, fever, chills, increased shortness of breath, and night sweats.
Patients who are suffering from other conditions may develop bronchiectasis. Conditions that can cause the initial damage and start the cycle of bronchiectasis include:
Foreign bodies, like tumors and lymph nodes, can block airways and prevent mucus from clearing out of the body. Also, human immunodeficiency virus (HIV), primary ciliary dyskinesia, organ transplant, allergic bronchopulmonary aspergillosis (ABPA), fibrosis, and alpha-1 antitrypsin deficiency can also spur the development of bronchiectasis in patients.
Additionally, patients can experience complications due to the disease. These complications include chronic inflammation and hypoxemia that can cause neovascularization of the bronchial arteries. Bronchial artery walls can easily rupture, which can cause severe and life-threatening hemoptysis. Patients may also experience pulmonary hypertension as a result of vasoconstriction, arteritis, and occasional shunts from bronchial to pulmonary vessels.
Understand How Bronchiectasis Is Diagnosed and Treated
The provider diagnoses bronchiectasis by listening to the lungs, accessing the patient’s history, and evaluating any other conditions that can cause it. Then, testing will be ordered and can include chest computed tomography (CT) scans or chest X-rays, blood tests and sputum cultures, pulmonary function tests (PFTs), genetic testing, sweat chloride tests, and bronchoscopies. Complications of bronchiectasis can be severe and lead to life-threatening conditions such as respiratory failure, severe bleeding, and antibiotic resistance.
Treatments include a combination of medication, hydration, and chest physical therapy. In some cases, providers use oxygen therapy to raise blood oxygen levels. Surgery is also an option for more severe cases when bronchiectasis is isolated to a section of the lung or when the patient experiences excessive bleeding. Providers may recommend that patients quit smoking, maintain a healthy diet, stay hydrated, take all prescribed medications, stay up to date on vaccinations, and take antibiotics when flare-ups occur.
Antibiotics are considered the most common treatment for bronchiectasis. Typically, oral antibiotics are prescribed, but intravenous (IV) antibiotics may be needed for more severe infections. The type of prescribed antibiotic depends on the bacteria that is causing the infection and if the bacteria is resistant to certain antibiotics. Common organisms include Haemophilus influenzae, Moraxella catarrhalis, Pseudomonas aeruginosa, Staphylococcus aureus, Streptococcus pneumoniae, and nontuberculous mycobacteria.
Pulmonologists may also administer expectorants to thin mucus and allow the patient to easily cough up the mucus. The expectorant is usually administered in the form of a nebulizer and a hypertonic solution that turns into a mist and is inhaled deep into the lungs. A decongestant can also be prescribed. Good hydration is key to keeping the mucus moist and slippery, so instructing the patient to drink plenty of fluids, especially water, is important.
Some of the most common devices used include oscillating positive expiratory pressure (PEP), intrapulmonary percussive ventilation (IPV), and posterior drainage. Chest physical therapy, or chest physiotherapy, is a technique where a physical therapist claps the patient’s chest to loosen the mucus from the lungs so it can be expelled. Patients may also wear electronic chest-clapping vests at home.
Providers can also teach breathing techniques to move the mucus to the upper airway in order to be coughed out. These techniques are called forced expiration technique (FET) and active cycle breathing (ACB). Bronchodilators and inhaled corticosteroids may be used to help treat inflammation in the airways as well.
Dive Into the Diagnosis Codes
The ICD-10-CM code book features the following codes in the J47.- (Bronchiectasis) code category:
The 4th character identifies whether an acute lower respiratory infection is present or whether the condition is exacerbated or decompensated. The uncomplicated option is the appropriate choice when neither of those conditions applies.
Parent code J47.- has a Use additional code note to identify tobacco exposure, history of, or current use of/dependence on tobacco products. Code J47.0 has a Code also note instructing you to report the type of infection, if applicable.
This code category belongs to the larger code section of J40-J47, which includes chronic bronchitis, chronic obstructive pulmonary disease (COPD), emphysema, and asthma. These conditions are grouped into the chronic lower respiratory diseases that affect the bronchus and lungs. These conditions comprise some of the leading causes of death in the U.S. A vast majority of these illnesses are attributable to cigarette smoking, although other risk factors include environmental exposures and genetic predisposition.
Cristin Robinson, CPC, CPMA, CCC, CRC, CEMC, Education Coding Consultant, Bristol, Tennessee
