Pulmonology Coding Alert

Question: Would you please tell me the code for lower respiratory infection?

Maryland Subscriber

Answer: Unlike an upper respiratory infection, there is no "catchall" ICD-9 code that identifies an unspecified "lower respiratory infection."
 
When the physician evaluates the patient, he determines what part of the patient's respiratory system is affected by the infection, such as the bronchial tree or the larynx.
 
When the physician suspects a condition affecting the lungs or "lower respiratory system," such as pneumonia, he can further identify the condition by the use of x-ray. The physician must document the specific condition to justify the most appropriate ICD-9 code based on the results of the x-ray (for example, 466.0, Acute bronchitis; or 481, Pneumococcal pneumonia). Documentation of the specific conditions will also help you to justify the medical necessity of the service.