Pulmonology Coding Alert

Question: I have a report where the pulmonologist diagnosed the patient with unspecified acute upper and lower respiratory infections. I attempted to use J06.9 and J22 together, but I noticed both codes have Excludes1 notes that exclude the other code.

How do I report the diagnoses?

Colorado Subscriber

Answer: This is quite the conundrum! For this situation, you’ll assign J22 (Unspecified acute lower respiratory infection) to report both respiratory infections.

The patient is experiencing respiratory infections simultaneously at different anatomical sites. While J06.9 (Acute upper respiratory infection, unspecified) and J22 have Excludes1 notes that essentially cancel each other out, the ICD-10-CM code set has an extra note that provides much-needed guidance for occasions such as yours.

In Chapter 10: Diseases of the Respiratory System (J00-J99), there is a chapter note before the Tabular List 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.” This means that you’ll assign the lower respiratory infection code to report both diagnoses.