Pulmonology Coding Alert

Question: Is the ICD9 code for extra-pulmonary TB 011.8(fifth digit)? The documentation read "the TB was found in lymph node smear from neck, AFB stained, that the beaded acid fast bacteria represent mycobacterium TB."

Kentucky Subscriber

Answer: Whenever you have a diagnosis of tuberculosis (TB), the first thing to check is to see the location in which the TB was found. If it is pulmonary, you will have to report it based on the associated respiratory conditions using one of the ten codes in 011 (Pulmonary tuberculosis) category. For example, if the diagnosis is tuberculous pneumonia, you will report 011.6 (Tuberculous pneumonia [any form]). Depending on the method used in the diagnosis, a fifth digit expansion should then be chosen.

If the diagnosis of tuberculosis is extra-pulmonary, you will have to choose from the appropriate code for the organ system. Depending on the organ system, you have the following set of codes you can choose from:

• 013 (Tuberculosis of meninges and central nervous system)
• 014 (Tuberculosis of intestines peritoneum and mesenteric glands)
• 015 (Tuberculosis of bones and joints)
• 016 (Tuberculosis of genitourinary system)
• 017 (Tuberculosis of other organs)

The ICD-9 code 017 further expands into ten codes using a fourth digit expansion. In the code scenario that you have described, since TB was found in the cervical lymph nodes, you will have to choose 017.2 (Tuberculosis of peripheral lymph nodes).

Next, you will have to check the diagnostic method to accurately report the condition using the fifth digit code. In the scenario that you have described, the fifth digit code is selected using the following criterion:

• 017.20 (Tuberculosis of peripheral lymph nodes unspecified examination)
• 017.21 (Tuberculosis of peripheral lymph nodes bacteriological or histological examination not done)
• 017.22 (Tuberculosis of peripheral lymph nodes bacteriological or histological examination results unknown [at present])
• 017.23 (Tuberculosis of peripheral lymph nodes tubercle bacilli found [in sputum] by microscopy)
• 017.24 (Tuberculosis of peripheral lymph nodes tubercle bacilli not found [in sputum] by microscopy but found by bacterial culture)
• 017.25 (Tuberculosis of peripheral lymph nodes tubercle bacilli not found by bacteriological examination but tuberculosis confirmed histologically)
• 017.26 (Tuberculosis of peripheral lymph nodes tubercle bacilli not found by bacteriological or histological examination but tuberculosis confirmed by other methods [inoculation of animals])

You can choose to report 017.23 if the diagnosis was made by microscopy. But, if your pulmonologist was using a smear obtained through an aspirate from the lymph nodes, that was checked histologically and confirmed for TB, then you will have to report 017.25.