Pulmonology Coding Alert

Question: A 3-year-old pediatric patient presented to a pulmonology practice with complaints of fever, dry cough, sore throat, body aches, and loss of appetite. The pulmonologist gathered a history, performed a physical examination, ordered a PCR test, and ordered a single-view chest X-ray. After interpreting the results, the pulmonologist diagnosed the patient with pneumonia due to adenovirus.

What diagnosis codes do I report for this encounter?

Texas Subscriber

Answer: You’ll assign J12.0 (Adenoviral pneumonia) to report the patient’s diagnosis. The patient’s viral pneumonia was caused by an adenovirus infection, which is one of the most common causes of viral pneumonia in the United States. Adenoviral pneumonia develops primarily in infants and children under 5 years old and makes up four to 10 percent of childhood pneumonia infections.

The condition is an upper respiratory tract infection with symptoms starting to show within 14 days after infection. Patients who contract adenovirus can experience sore throat, runny nose, severe cough, fever, headache, pink eye, and swollen lymph nodes. If the infection progresses, it can cause pneumonia, as in the case you’ve presented.

If the results cannot confirm at the time of the patient visit, the physician should only assign the code(s) representing the patient’s signs/symptoms.