Pulmonology Coding Alert

Question: What are the correct ICD-9 codes for the following types of pulmonary edema: pulmonary edema associated with heart disease such as a myocardial infarction, pulmonary edema that is not cardiogenic in origin, and chronic pulmonary edema? What about acute pulmonary edema in adult respiratory distress syndrome?

New York Subscriber

Answer: You should use 428.1 for left ventricular failure due to acute pulmonary edema associated with acute myocardial infarction, acute or subacute ischemic heart disease, or coronary atherosclerosis. If the patient has left ventricular failure with congestive/right heart failure, however, you should use 428.0. Noncardiogenic acute pulmonary edema is classified to disease of the lung or to trauma as directed by the ICD-9 index. However, if the patient has acute pulmonary edema (518.4) as a result of adult respiratory distress syndrome (ARDS), use 518.5 (in addition to 518.4). Chronic pulmonary edema or pulmonary edema not otherwise specified as acute or chronic is coded using 514.

The physician should always document the etiology of pulmonary edema, if known, to facilitate selection of the correct ICD-9 code. Having specific references in the documentation will assist in selecting the most accurate and appropriate code representing the patients condition.