Pulmonology Coding Alert

Question: A pulmonologist in a private practice saw a patient who was experiencing chest pain, cough, fever, and shortness of breath. The physician ordered a chest CT scan, and the images showed increased fluid in the patient's pleural space. After reviewing the results, the pulmonologist diagnosed the patient with bronchopleural fistula.

What diagnosis codes should I assign?

Louisiana Subscriber

Answer: You will assign J86.0 (Pyothorax with fistula) to report the documented diagnosis. Bronchopleural fistula is an additional synonym listed under J86.0, as well as:

• Bronchocutaneous fistula
• Hepatopleural fistula
• Mediastinal fistula
• Pleural fistula
• Thoracic fistula

The list of conditions also includes “Any condition classifiable to J86.9 [Pyothorax without fistula] with fistula.” This means that you’ll select J86.0 if your provider documents any of the following J86.9 conditions as occurring with a fistula:

• Abscess of pleura
• Abscess of thorax
• Empyema (chest) (lung) (pleura)
• Fibrinopurulent pleurisy
• Purulent pleurisy
• Pyopneumothorax
• Septic pleurisy
• Seropurulent pleurisy
• Suppurative pleurisy

Pyothorax occurs when pus enters the pleural cavity between the membrane that lines the thoracic cage and the membrane that covers the lungs. The condition commonly happens when an infection spreads from an inflamed lung to the pleural membrane. The patient may also experience different forms of tuberculosis or a lung abscess because of the infection.

A fistula happens when two hollow spaces, such as organs, intestines, or blood vessels, form an abnormal connection. This can occur due to surgery, injury, infection, or inflammation.

Important: J86.0 features a Code also note instructing you to use T81.32- (Disruption of internal operation (surgical) wound, not elsewhere classified) to report surgical complications that could occur following an operation, if applicable.

Additionally, the parent code J86.- (Pyothorax) features a Use additional code note and an Excludes1 note. The Use additional code note instructs you to include the appropriate code from B95-B97 to identify the infectious agent, while the Excludes1 note doesn’t allow you to code J86.0 or J86.9 with J85.- (Abscess of lung and mediastinum) or A15.6 (Tuberculous pleurisy).

Mike Shaughnessy, BA, CPC, Development Editor, AAPC