Chemotherapy induced pneumonitis
ICD-10-CM/PCS Coding Clinic, Second Quarter ICD-10 2019 Page: 28 Effective with discharges: June 21, 2019
Question:
A patient with history of metastatic breast cancer is diagnosed with hypoxemic acute respiratory failure, due to Paclitaxel/chemotherapy induced pneumonitis. Coding professionals are unclear whether it is appropriate to assign code J18.9, Pneumonia, unspecified organism, or code J84.89, Other specified interstitial pulmonary disease, to capture pneumonitis, as the medical literature describes pneumonitis as a noninfectious side effect associated with chemotherapy. What is the correct code assignment for chemotherapy induced pneumonitis?
Answer:
If the pneumonitis due to chemotherapy is documented as acute, assign code J70.2, Acute drug-induced interstitial lung disorders, followed by code T45.1X5A, Adverse effect of antineoplastic and immunosuppressive drugs, initial encounter, for Paclitaxel/chemotherapy induced pneumonitis. If the condition is not specified as acute, assign code J70.4, Drug-induced interstitial lung disorders, unspecified, rather than code J70.2. When coding an adverse effect of a drug that has been correctly prescribed and properly administered, assign the appropriate code for the nature of the adverse effect followed by the appropriate code for the adverse effect of the drug (T36-T50).
Code J84.89, Other specified interstitial pulmonary disease, is not appropriate because of the Excludes1 note at category J84 for "drug-induced interstitial lung disorders (J70.2-J70.4)."