Pulmonology Coding Alert

What diagnosis codes should I report for this encounter?

New Hampshire Subscriber

Answer: You just need J84.01 (Alveolar proteinosis) to report the confirmed PAP diagnosis. The single code covers both primary and secondary alveolar proteinosis, so even if the provider’s documentation specifies the type of PAP, you can report the sole ICD-10-CM code for the condition.

However, if the pulmonologist did document a secondary alveolar proteinosis diagnosis, you should identify the cause of the condition, which could be a lung infection or dust inhalation. The cause codes fall under the parent code J84.- (Other interstitial pulmonary diseases) Excludes2 note which instructs you to assign applicable codes from J60-J70, Lung diseases due to external agents.

Condition breakdown: Patients suffering from PAP have difficulty exchanging carbon dioxide in the blood with oxygen from the air due to the buildup of lipids and proteins in the lungs air sacs. Symptoms associated with PAP include shortness of breath, cough, and dyspnea.

According to the ICD-10-CM Official Guidelines, section I.C.18.a, you are to report signs and symptoms codes “when a related definitive diagnosis has not been established

(confirmed) by the provider.” This means that if the pulmonologist didn’t document a definitive PAP diagnosis, you’d report codes for the symptoms the patient presented during the encounter. In that case, you’d assign R06.02 (Shortness of breath) and R05.2 (Subacute cough).

Cough code differences: ICD-10-CM code R05.- (Cough) is a parent code that requires a 4th character to specify the patient’s condition. When coding a cough symptom, make sure to check the documentation for a definitive description of the cough, so you can accurately report the symptom. For example, the provider may document how long the patient has been experiencing the symptom, which helps you choose from R05.1 (Acute cough), R05.2, and R05.3 (Chronic cough).

An acute cough typically lasts up to three weeks, a subacute cough may persist from three to eight weeks, and a chronic cough lasts longer than eight weeks, but you should base your coding on the provider’s documentation of acute, subacute, or chronic.