Radiology Coding Alert

Make the correct choice between acute and chronic sinusitis codes.

If the term chronic isn’t included as a keyword, common sense might suggest that you should default to an acute sinusitis code. However, most coders know that when you’re working with ICD-10, you go where the index tells you to go. Still, the inevitable truth is that the index can only take you so far when it comes to particular diagnoses.

Sinusitis coding is one of those areas of ICD-10 that seems basic on the surface, but can become increasingly problematic the more specific a code becomes. Consider a few examples:

Indication: Sinusitis

You will refer to the default sinusitis code with no specifying indicator at hand:

• J32.9: Chronic Sinusitis, unspecified

While there are clearly no indications that the sinusitis is, in fact, chronic, ICD-10 requires you to code any unspecified documented sinusitis as chronic.

Indication: Sinusitis for 8 weeks

Here, you’ve got a timeframe, but nothing else to consider when choosing a code. In this case, it’s important to know the rules pertaining to when acute sinusitis becomes chronic. According to the American Academy of Otolaryngology – Head and Neck Surgery (AAOHNS), acute sinusitis is “diagnosed when symptoms last up to 4 weeks.” Chronic sinusitis, on the other hand, “lasts for 12 weeks or longer.” With this information at hand, you can decisively code this indicating diagnosis as acute sinusitis:

• J01.90: Acute sinusitis, unspecified

Indication: Acute, recurrent ethmoid and maxillary sinusitis

You need to analyze this one from two different perspectives. First, you know that it’s an acute, recurrent form of sinusitis. Second, you know that you’re dealing with sinusitis of the ethmoid and maxillary sinuses. This diagnosis offers a great lesson in making sure to read each term listed under your indexed diagnosis before reaching any presumed diagnostic conclusion.

In this case, you might instinctively head immediately towards Sinusitis à acute à ethmoidal/maxillary à recurrent. However, if you scroll a little bit further down, you’ll see the correct route is to bypass “Acute” and » » head straight for “involving more than one sinus, but not pansinusitis.” You’ll then reach acute à recurrent à J01.81:

• J01.81: Acute, recurrent sinusitis involving more than one sinus but not pansinusitis

When to Code Pansinusitis

In the field of medical coding, your skillset and knowledge can only take you as far as the doctor’s dictation allows. This is particularly applicable when it comes to ICD-10 coding. The wording behind a particular diagnosis can go a long way in making your job exponentially easier. This rule applies to sinus disease coding among numerous other anatomical structures.

You’ve now been briefed on the example of when the provider documents sinusitis in more than one sinus, but not in all four. What if sinusitis is separately documented in all four sinuses, but there’s no reference to pansinusitis? It’s instances like these where an established relationship between coder and physician can go a long way.

However, if you do find yourself in this particular coding predicament, you’ve got the option of going in one of two directions. The first is to code the indicating diagnosis as pansinusitis since it technically reaches the clinical definition of pansinusitis. The other option would be to code each sinusitis diagnosis separately.

The decision might be made easier for you if the degrees of sinusitis vary between chronic and acute (in which case you’d code individually), but that is unlikely to be the case in most circumstances. So, which is the correct route?

“Care needs to be taken when coding sinusitis,  because it is one of the few codes in ICD-10 that defaults to chronic,” explains Lindsay Della Vella, COC, medical coding auditor at Precision Healthcare Management in Media, Pennsylvania. “If sinusitis is documented on three or more sinuses unilaterally, you will apply code J32.4 (Chronic pansinusitis). All of the chronic sinusitis codes are found in the J32- section of the ICD-10 index, which falls under the subsection‘Other diseases of upper respiratory tract (J30-J39).’”

“Similarly, if the acute sinusitis is documented in three or more sinuses unilaterally, the same logic applies,” Della Vella continues. “It is still coded as pansinusitis, but as acute pansinusitis, which falls under code J01.4- (Acute pansinusitis…).” You can find the acute sinusitis codes under the subsection “Acute upper respiratory infections (J00-J06)” in ICD-10.