Pulmonology Coding Alert

Question: Can you code acute respiratory failure and pulmonary infiltrates together?

Texas Subscriber

Answer: You won’t find a single ICD-10 code to code and pulmonary infiltrates and respiratory failure together in a patient, so you will need to report separate codes for both.

When coding acute respiratory failure as a primary diagnosis, you can start by assigning J96.0- (Acute respiratory failure…) or J96.2- (Acute and chronic respiratory failure…). From there, you will need to heed other chapter specific coding guidelines.

When you come across acute respiratory failure as a secondary diagnosis that is occurring with another acute condition, your principal diagnosis will be based on the cause of admission. According to the coding guideline that provides information for acute respiratory failure, if respiratory failure is the chief cause for the medical visit, this will be your primary diagnosis. The condition can be both acute and chronic in nature, and can be documented using J96.0 (Acute respiratory failure) or J96.2 (Acute and chronic respiratory failure). Even though an associated condition can arise, acute respiratory failure can still be listed as the primary reason for the visit.

A plain respiratory failure with no specifications can be safely coded as J96.90 (Respiratory failure, unspecified, unspecified whether with hypoxia or hypercapnia). However, a specification whether the condition is acute or chronic is necessary to support certain procedures or services (eg, critical care services, 99291). Further, based on the arterial blood gas report, you can add the fifth character to these respiratory failure category of codes: 1 for hypoxia, 2 for hypercapnia, or 0 for unspecified.

For reporting the pulmonary infiltrate, report R91.8 (Other nonspecific abnormal finding of lung field). The long descriptor also covers “Lung mass NOS found on diagnostic imaging of lung, Pulmonary infiltrate NOS, and Shadow, lung” here. This is classified as a sign/symptom that can justify the need for further diagnostic testing. Report this unless a more definitive diagnosis is determined.