Pulmonology Coding Alert

Question: When coding for acute respiratory failure, what is the difference between ICD-9 codes 518.5 and 518.81?

Washington Subscriber

Answer: Remember, always base your diagnosis coding on your physician's actual chart documentation. ICD-9-CM guidelines denote that 518.5 (Pulmonary insufficiency following trauma and surgery) describes both adult respiratory distress syndrome (ARDS) and pulmonary insufficiency following shock, surgery or trauma. Meanwhile, you may bill 518.81 (Acute respiratory failure) if the patient suffers from acute respiratory failure related to other conditions (e.g., pneumonia) or a respiratory failure not otherwise specified. This is the case when the information in the medical record is insufficient to assign a more specific code for the failure.

Background: ARDS is a severe form of lung dysfunction that is caused by direct injury to the lungs. Pulmonologists most often diagnose and treat this disorder in a hospital's intensive care unit (ICU).

Pulmonologists would typically order these tests and procedures to diagnose ARDS:

• Arterial blood gas (ABG) studies (36600, Arterial puncture, withdrawal of blood for diagnosis; or 36620, Arterial catheterization or cannulation for sampling, monitoring or transfusion [separate procedure]; percutaneous);
• Chest x-rays (71010-71035);
• Pulmonary artery catheterization (93503, Insertion and placement of flow directed catheter [e.g., Swan-Ganz] for monitoring purposes).

Warning: Do not report 518.5 to show medical necessity for these tests and procedures. You should report the signs and symptoms the patient exhibits unless the pulmonologist is sure of the final diagnosis. Symptoms for ARDS may include shortness of breath (786.05), respiratory failure (518.81), pneumonia (486) or sepsis (038.9).