Radiology Coding Alert

Question: We have a patient with diagnoses of chronic frontal sinusitis with ocular and bilateral ear pain. Additionally, the patient presents with a fever and mild fatigue. Should I code any of these signs and symptoms since we have a principal diagnosis of chronic frontal sinusitis?

New York Subscriber

Answer: This is a tricky question that requires a strong understanding of ICD-10-CM guidelines to answer correctly. Some coders may incorrectly assume that the principal diagnosis is the only valid diagnosis here since the additional presenting diagnoses are typical for a patient with frontal sinusitis. However, the correct answer to this question is a little more complicated than that.

First, take a look at the ICD-10-CM guidelines regarding signs and symptoms associated with the underlying diagnosis:

• "Signs and symptoms that are associated routinely with a disease process should not be assigned as additional codes, unless otherwise instructed by the classification."

Next, take a look at the guidelines for diagnoses with conditions that may not typically present with the underlying condition:

• "Additional signs and symptoms that may not be associated routinely with a disease process should be coded when present."

With these guidelines at your disposal, it's clear that the answer requires the coder to understand what signs and symptoms typically present with chronic frontal sinusitis. It's questions such as this that outline the importance of the anatomy and medical terminology sections of the Certified Professional Coder (CPC) exam, for example. Taking a look at the presenting signs and symptoms, coders can immediately rule out a few options. Since the frontal sinuses are located in between/behind the eyes, a symptom of ocular pain is to be expected with frontal sinusitis. Similarly, a fever and fatigue are also common symptoms a patient may experience with any form of sinusitis.

Therefore, you can immediately rule out three of the four presenting signs and symptoms diagnoses. However, you should take a moment to consider whether a diagnosis of ear pain applies to the first or second of the guidelines listed above. Unlike ocular pain, ear pain is not necessarily a common symptom of frontal sinusitis. Therefore, it is appropriate to include H92.03 (Otalgia, bilateral) in addition to your principal diagnosis code of J32.1 (Chronic frontal sinusitis).