Pulmonology Coding Alert

CD-9 2008 will give you one more choice in the commonly reported 415.1x subcategory When two septic embolism ICD-9 codes debut this fall, you'll have to relegate the codes to at least Dx2 and choose the right diagnosis based on the disease's origin. Grant Septic Pulmonary Embolism Its Own Code ICD-9 2008 will add one code to 415.1x (Pulmonary embolism and infarction). As of Oct. 1, 2007, you will be able to indicate "septic pulmonary embolism" with 415.12.

Good news: You'll be able to specify this disease, rather than having to lump it under an "other specified" code. ICD-9 2007 contains no entry for embolism, septic. "Septic pulmonary embolism currently would be coded to 415.19 (... other), along with codes for septicemia and sepsis, as appropriate," according to the ICD-9-CM Coordination and Maintenance Committee Meeting Sept. 28-29, 2006, Diagnosis Agenda. Always Code Septicemia as Primary When 415.12 becomes valid, the "code also" instructions will remain intact. You will still first code the underlying infection, such as septicemia (038.0-038.9).

Example: A 24-year-old IV drug abuser enters the hospital with fever, shortness of breath and pulmonary infiltrates, one of which has a small cavity in it. Staphylococcus aureus is cultured from the blood, and the pulmonologist diagnoses tricuspid endocarditis. "You would code 038.11 for the staphylococcal septicemia, 421.0 for acute bacterial endocarditis, 041.11 for staphylococcus aureus, and 415.12 for septic pulmonary emboli," says Alan L. Plummer, MD, professor of medicine, Division of Pulmonary, Allergy, and Critical Care at Emory University School of Medicine in Atlanta.

Watch out: If septic pulmonary embolism (SPE) also causes subsequent lung abscess or necrotizing pneumonia, you should code that condition as well. Report either lung abscess or necrotizing pneumonia as 513.0 (Abscess of lung).

Use 449 for Any Septic Arterial Embolism Thanks to an additional request from the Coding Clinic's Editorial Advisory Board, you can look forward to the introduction of one more septic disease. ICD-9 2008 will also debut new code 449 for "septic arterial embolism."

Change: Starting Oct. 1, you'll classify the disease to a whole new subcategory. Septic arterial embolism now falls under 444.9 (Arterial embolism and thrombosis; of unspecified artery).

And the singular code 449 will describe a septic embolism of any artery. National Center for Health Statistics (NCHS) staff had proposed to add five codes to the subcategory, which would allow you to specify the artery. But after commenters questioned the need for these codes, the Centers for Disease Specialists decided to consolidate the disease under one code. Restrict Arterial Embolism to Secondary Dx Just like 415.12, you'll never use 449 in the primary position. When a pulmonologist diagnoses a patient with septic arterial embolism, you will first code the underlying infection, such as infective endocarditis (421.0, Acute [...]