Pulmonology Coding Alert

Question: A patient presented experiencing a severe cough, shortness of breath, and fatigue. A pulmonologist diagnosed the patient with unspecified acute upper and lower respiratory infections.

When I attempt to code the diagnoses, I see that both J06.9 (Acute upper respiratory infection, unspecified) and J22 (Unspecified acute lower respiratory infection) have Excludes1 notes. The note for J06.9 excludes J22 and the note for J22 excludes J06.9.

How do I code the patient’s diagnoses?

Florida Subscriber

Answer: For your situation, you’ll assign J22 to report both respiratory infections.

This is certainly a tricky question. Both infections are occurring simultaneously at different anatomical sites in the body. Even though each code has a note to exclude the other code, the ICD-10-CM code set has a separate note. Before the start of the tabular list in Chapter 10: Diseases of the Respiratory System (J00-J99), there is a chapter note that reads, “When a respiratory condition is described as occurring in more than one site and is not specifically indexed, it should be classified to the lower anatomic site.”