Basic ICD-10-CM/PCS Coding 2013 Edition

1. Basic ICD-10-CM/PCS Coding2013 Edition Chapter 13: Diseases of the Respiratory System (J00–J99)

2. Learning Objectives • Review the chapter’s learning objectives and key terms • At the conclusion of this chapter, what must you know about the coding of respiratory diseases and related procedures?

3. ICD-10-CM Chapter 10: Diseases of the Respiratory System (J00–J99) Chapter 10 is organized into the following blocks J00–J06 Acute upper respiratory infections J09–J18 Influenza and pneumonia J20–J22 Other acute lower respiratory infections J30–J39 Other diseases of upper respiratory tract J40–J47 Chronic lower respiratory diseases J60–J70 Lung diseases due to external agents

4. ICD-10-CM Chapter 10: Diseases of the Respiratory System (J00–J99) Chapter 10 is organized into the following blocks J80–J84 Other respiratory diseases principally affecting the interstitium J85–J86 Suppurative and necrotic conditions of lower respiratory tract J90–J94 Other diseases of pleura J95 Intraoperative and postproceduralcomplications J96–J99 Other diseases of the respiratory system

5. ICD-10-CM Chapter 10: Diseases of the Respiratory System (J00–J99) Contains current respiratory disease terminology Category J43, Emphysema, contains codes with panlobular emphysema and centrilobular emphysema Category J45, Asthma, classifies asthma as mild intermittent, mild persistent, moderate persistent, and severe persistent

6. Coding Instructional Notes for ICD-10-CM Chapter 10 At beginning of chapter is the following instructional note: 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. For example, Tracheobronchitis is classified to bronchitis in J40, Bronchitis, not specified as acute or chronic

7. Coding Instructional Notes for ICD-10-CM Chapter 10 Another note at beginning of chapter is the following: Use additional code, when applicable, to identify: Exposure to environmental tobacco smoke Exposure to tobacco smoke in the perinatal period History of tobacco use Occupational exposure to environmental tobacco smoke Tobacco dependence Tobacco use

8. Coding Instructional Notes for ICD-10-CM Chapter 10 Notes indicate when an additional code should be assigned or an associated condition sequenced first. Use additional code to identify the infectious agent Use additional code to identify the virus Code first any associated lung abscess Code first the underlying disease Use additional code to identify other conditions such as tobacco use or exposure

9. Coding Instructional Notes for ICD-10-CM Chapter 10 Example of Excludes Notes There is an Excludes2 note under category code J45, Asthma, for asthma with chronic obstructive pulmonary disease By definition, this means it is acceptable to use both the code and the excluded code together if the patient has both conditions at the same time.

10. Coding Guidelines for ICD-10-CM Chapter 10 ICD-10-CM chapter specific guidelines exist for: Chronic obstructive pulmonary disease and asthma Addresses acute exacerbation of chronic obstructive bronchitis and asthma Acute respiratory failure Acute respiratory failure as principal diagnosis Acute respiratory failure as a secondary diagnosis Sequencing of acute respiratory failure and another acute condition

11. Coding Guidelines for ICD-10-CM Chapter 10 ICD-10-CM chapter specific guidelines exist for: Influenza due to certain identified influenza viruses Code only confirmed cases of influenza due to certain identified influenza viruses (J09) and due to other identified influenza virus (J10) Ventilator-associated pneumonia Documentation of ventilator associated pneumonia Ventilator associated pneumonia develops after admission

12. Coding Diseases of the Respiratory System in ICD-10-CM Chapter 10 Acute upper respiratory infections (J00–J06) Acute infections in the nose, sinuses, pharynx, tonsils, larynx, and trachea Use additional code to identify the infectious agent Excludes1 notes identify when conditions cannot be coded together Excludes2 notes identify conditions that can exist and coded concurrently

13. Coding Diseases of the Respiratory System in ICD-10-CM Chapter 10 Influenza (J09–J11) Three categories to describe the type of influenza virus and the respiratory conditions it produces Influenza due identified novel influenza A virus (J09) Influenza with pneumonia, other respiratory manifestations and gastrointestinal manifestation Influenza due to other identified influenza virus (J10) Use additional codes and Code also notes included here Influenza due to unidentified influenza virus (J11) The exact type of influenza virus cannot be identified

14. Coding Diseases of the Respiratory System in ICD-10-CM Chapter 10 Pneumonia (J12–J18) Viral pneumonia, not elsewhere classified Pneumonia due to Streptococcus pneumoniae Pneumonia due to Hemophilus influenzae Bacterial pneumonia, not elsewhere classified Pneumonia due to other infectious organisms, NEC Pneumonia in diseases classified elsewhere Pneumonia unspecified organism

15. Coding Diseases of the Respiratory System in ICD-10-CM Chapter 10 Viral pneumonia is a highly contagious disease affecting both the trachea and bronchi of the lungs. Adenovirus, respiratory syncytial virus, parainfluenza, SARS-associated corona virus and other specified viruses. Pneumonia due to Streptococcus pneumoniae may be called bronchopneumonia due to S. pneumoniae. The bacteria lodge in the alveoli and cause inflammation. If the pleura are involved, the irritated surfaces rub together and cause pleural breathing and the physician may describe hearing pleural friction.

16. Coding Diseases of the Respiratory System in ICD-10-CM Chapter 10 Pneumonia due to Hemophilus influenza May be called bronchopneumonia due to H. influenza Condition may occur with a lung abscess Bacterial Pneumonia, NEC Subcategories identify Klebsiella pneumoniae, Pseudomonas, Staphylococcus, Streptococcus and other specified types Bacteria is the most common cause of pneumonia in adults

17. Coding Diseases of the Respiratory System in ICD-10-CM Chapter 10 Pneumonia due to other infectious organisms NEC Organisms other than bacteria cause pneumonia, such as chlamydia Pneumonia in diseases classified elsewhere Types of pneumonia identified here are the result or a complication of another disease. Code is italicized so it cannot be the first or single code used Pneumonia, unspecified Used when the physician cannot identify if a particular bacteria, virus or other organism caused the pneumonia

18. Coding Diseases of the Respiratory System in ICD-10-CM Chapter 10 Other acute lower respiratory infections Acute bronchitis is an inflammation of the tracheo-bronchial tree with a short and more or less severe course Chronic bronchitis is associated with prolonged exposure to nonspecific bronchial irritants and is accompanied by mucus hypersecretion and structural changes in the bronchi Bronchiolitis is acute inflammatory disease of the bronchioles usually caused by a viral infection and most often affects children under the age of two years

19. Coding Diseases of the Respiratory System in ICD-10-CM Chapter 10 Other diseases of the upper respiratory tract Chronic conditions of body parts within the upper respiratory system Vasomotor and allergic rhinitis Chronic rhinitis Chronic sinusitis Nasal polyp Chronic diseases of tonsils and adenoids Peritonsillar abscess Chronic laryngitis and laryngotracheitis Diseases of the vocal cords and other conditions

20. Coding Diseases of the Respiratory System in ICD-10-CM Chapter 10 Chronic lower respiratory disease Chronic bronchitis is included in the section titled “chronic obstructive pulmonary disease and allied conditions” or COPD Specific types of chronic bronchitis included here The diagnosis of ‘bronchitis’ not specified as acute or chronic included here. When the physician documents ‘bronchitis’ for a child or young adult, the physician should be asked to clarify the type of bronchitis as it is may not be a chronic form of the disease as these codes are intended to represent

21. Coding Diseases of the Respiratory System in ICD-10-CM Chapter 10 Chronic lower respiratory disease Emphysema is a specific type of COPD when there is permanent enlargement of the air spaces down to the terminal bronchioles; frequently associated with chronic bronchitis Centroacinar emphysema or centrolobular emphysema is associated with long-standing cigarette smoking and involves the upper half of the lungs Panacinar or panlobular emphysema destroys the entire alveolus uniformly and is predominant in the lower half of the lungs

22. Coding Diseases of the Respiratory System in ICD-10-CM Chapter 10 Chronic obstructive pulmonary disease Diffuse obstruction of the smaller bronchi and bronchioles that results in coughing, wheezing, shortness of breath and disturbances of gas exchange Exacerbation of COPD include episodes of increased shortness of breath and cough with severe exacerbations such as infections that usually result in admission to a hospital The diagnosis of COPD is an unspecified form of the disease as COPD may also be documented as chronic bronchitis, obstructive asthma or emphysema

23. Coding Diseases of the Respiratory System in ICD-10-CM Chapter 10 Asthma Recurrent attacks of paroxysmal dyspnea with wheezing due to spasmodic contraction of the bronchi. Types of asthma include allergic, extrinsic, nonallergic, and intrinsic Asthma may also be coded with chronic obstructive pulmonary disease as it may be described as chronic asthmatic obstructive bronchitis or chronic obstructive asthma Asthma severity terms are intermittent, mild, moderate, or severe persistent

24. Coding Diseases of the Respiratory System in ICD-10-CM Chapter 10 Asthma Fifth digits are used to identify when the patient was in status asthmaticus or having an exacerbation or acute exacerbation of the asthma Acute exacerbation or exacerbation is an increase in the severity of the disease or any of its signs or symptoms, such as wheezing or shortness of breath Status asthmaticus is an acute asthmatic attack in which the degree of bronchial obstruction that is not relieved by usual treatments.

25. Coding Diseases of the Respiratory System in ICD-10-CM Chapter 10 Bronchiestasis Chronic, congenital or acquired disease characterized by irreversible dilation of the bronchi with secondary infection; occurs in children and adults May exist with acute lower respiratory infections or with acute or other exacerbation of bronchiectasis

26. Coding Diseases of the Respiratory System in ICD-10-CM Chapter 10 Lung diseases due to external agents Lung diseases caused by external factors, chemicals, organix and inorganic substances. Examples include: Coalworkers’ pneumonoconiosis Pneumonoconiosis due to asbestos, dust and other inorganic dusts and other causes Hypersensitivity pneumonitis due to organic dust Pneumonitis due to solids and liquids, which the most commonly coded condition is aspiration pneumonia Respiratory conditions due to other external agents

27. Coding Diseases of the Respiratory System in ICD-10-CM Chapter 10 Other categories to classify diseases of the respiratory system Conditions classified here include Acute respiratory distress syndrome Acute pulmonary edema Chronic pulmonary edema Pulmonary fibrosis Pleural effusion Spontaneous tension and primary pneumothorax Hemothorax and hemopneumothorax

28. Coding Diseases of the Respiratory System in ICD-10-CM Chapter 10 Intraoperative and postprocedural complications and disorders of respiratory system, NEC Tracheostomy complications Acute and chronic pulmonary insufficiency following thoracic surgery and nonthoracic surgery Postprocedural pneumothorax and air leak Ventilator associated pneumonia Hemorrhage, hematoma Accidental puncture or laceration

29. Coding Diseases of the Respiratory System in ICD-10-CM Chapter 10 Respiratory failure Inability of the respiratory system to supply adequate oxygen to maintain proper metabolism and/or to eliminate carbon dioxide. Types of failure include the unspecified type or that present with hyoxia or hypercapnia described as Acute Chronic Acute and chronic Unspecified

30. Coding Diseases of the Respiratory System in ICD-10-CM Chapter 10 Coding and sequencing respiratory failure Acute respiratory failure may be assigned as principal or first-listed or as a secondary diagnosis Chapter specific guidelines for obstetrics, poisoning, HIV and newborn diseases provide sequencing direction There is not one respiratory failure coding rule Respiratory failure is a life-threatening condition that is always caused by an underlying condition with the primary goal of treatment to assess the severity of the underlying disease and to correct the inadequate oxygen delivery

31. Coding Diseases of the Respiratory System in ICD-10-CM Chapter 10 Bronchospasm Acute bronchospasm is frequently a symptom of another respiratory condition. Excludes1 note states bronchospasm is not coded with Acute bronchiolitis with bronchospasm Acute bronchitis with bronchospasm Bronchospasm with asthma Exercise induced bronchospasm

32. Coding Procedures of the Respiratory System in ICD-10-PCS Chapter 10 ICD-10-PCS Tables 0B1–0BY for respiratory procedures Root operations of Bypass, change, destruction, dilation, drainage Excision, extirpation, fragmentation, insertion, inspection Occlusion, reattachment, release, removal, repair, reposition Resection, supplement, restriction, revision, and transplantation

33. Coding Procedures of the Respiratory System in ICD-10-PCS Chapter 10 ICD-10-PCS Tables 0C0–0CX for mouth and throat procedures Root operations of Alteration, change, destruction, dilation, drainage Excision, extirpation, extraction, fragmentation, insertion, inspection Occlusion, reattachment, release, removal, repair, replacement, reposition Resection, supplement, restriction, revision, and transfer

34. Coding Procedures of the Respiratory System in ICD-10-PCS Chapter 10 Closed endoscopic biopsy Excision of tissue for diagnostic purposes through a bronchoscope in the respiratory system Biopsy defined in ICD-10-PCS is an excision or cutting out or off, without replacement, a portion of a body part ICD-10-PCS Table 0BB with Fourth character to identify the body part, such as specific bronchus Fifth character to identify the approach, such as endoscopic Sixth character does not apply Seventh character identifies if it is a diagnostic procedure (X)

35. Coding Procedures of the Respiratory System in ICD-10-PCS Chapter 10 Mechanical ventilation Invasive mechanical ventilation pumps air into the patient’s lungs even when there is no attempt by the patient to breathe on his or her own when the patient has apnea, acute respiratory failure or impending respiratory failure Coded to the Extracorporeal Assistance and Performance section Insertion of the endotracheal tube as part of mechanical ventilation is not coded as a separate procedure

36. Exercises Practice coding the conditions included in Chapter 10 of ICD-10-CM for diseases of the respiratory system as well as the procedures used to treat these conditions by completing the review exercises for Chapter 13.