Pulmonology Coding Alert

Question: I enjoyed the information provided in the article “Sift Through Descriptors to Bolster Your Bronchoscopy Coding Skills” in Pulmonology Coding Alert, Volume 23, Issue 10. Using the scenario presented in the article as an example, would I still report C34.11 if the pathology report hadn’t returned by the time I receive the report to code the encounter?

Colorado Subscriber

Answer: To briefly recap a portion of the article, a scenario was presented where a patient is diagnosed with a primary malignant neoplasm of the right upper lobe (RUL), which is coded to C34.11 (Malignant neoplasm of upper lobe, right bronchus or lung).

However, if the pathology report hadn’t returned by the time you needed to code the encounter, you wouldn’t report C34.11 because the provider wouldn’t have made a definitive diagnosis of primary malignant neoplasm of the patient’s lung. The provider would only know what symptoms the patient was exhibiting. For example, if the patient was suffering from coughing up blood, chest pain when deep breathing, feeling hoarse, and shortness of breath, then the provider would document those symptoms in the patient’s record. The provider may also document that chest X-rays revealed a suspicious mass in the RUL, but this would be regarded as “abnormal imaging” rather than an absolute condition.

According to ICD-10-CM Official Guidelines, Section I.B.4, you’ll code the signs and symptoms “when a related definitive diagnosis has not been established (confirmed) by the provider.” Instead of reporting C34.11, you could report any of the symptoms or signs listed in the medical documentation, such as:

• R04.2 (Hemoptysis) or coughing up blood
• R07.1 (Chest pain on breathing)
• R49.0 (Dysphonia) or hoarseness
• R06.02 (Shortness of breath)
• R91.8 (Other nonspecific abnormal finding of lung field)

Code R91.8 features an additional synonym of “Lung mass NOS found on diagnostic imaging of lung,” which allows you to use the code to report an unspecified mass in the lung discovered on a chest X-ray.