S INUSITIS AND B RONCHITIS Beth Sassano CPC-I, CPC, CPMA, CCS-P

E PIDEMIOLOGY Sinusitis is a common condition, with between 24– 31 million cases occurring in the United States annually. Chronic sinusitis affects approximately 12.5% of people. WebMD defines sinusitis as “an inflammation, or swelling, of the tissue lining the sinuses”.

PER W IKIPEDIA : Recurrent acute rhinosinusitis – Four or more separate episodes of acute sinusitis that occur within one year SubacuteSubacute rhinosinusitis – An infection that lasts between four and 12 weeks, and represents a transition between acute and chronic infection ChronicChronic rhinosinusitis – When the signs and symptoms last for more than 12 weeks. Acute exacerbation of chronic rhinosinusitis – When the signs and symptoms of chronic rhinosinusitis exacerbate, but return to baseline after treatment All these types of sinusitis have similar symptoms, and are thus often difficult to distinguish. Acute sinusitis is very common. Roughly ninety percent of adults have had sinusitis at some point in their lifesymptoms

C HAPTER 10 CD-10-CM codes for sinusitis are found in chapter 10, Diseases of the Respiratory System, which includes codes J00-J99. ICD-10-CM instructional notes at the beginning of the chapter tell you to use an 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

C HAPTER There are two Excludes notes: Excludes1 note:States not to use these codes to describe sinusitis, not otherwise specified (NOS), which would be coded as J32.9 Chronic sinusitis, unspecified. Excludes2 note: States that if the patient also has documented chronic sinusitis, it should be coded in addition to the code for the acute condition.

A CUTE S INUSITIS It is difficult to distinguish between bacterial and viral sinusitis. However, if symptoms last less than 10 days, it is generally considered viral sinusitis. When symptoms last more than 10 days, it is considered bacterial sinusitis.

A CUTE S INUSITIS J01J01 Acute sinusitis J01.0J01.0 Acute maxillary sinusitis J01.00J01.00 …… unspecified J01.01J01.01 Acute recurrent maxillary sinusitis J01.1J01.1 Acute frontal sinusitis J01.10J01.10 …… unspecified J01.11J01.11 Acute recurrent frontal sinusitis J01.2J01.2 Acute ethmoidal sinusitis J01.20J01.20 …… unspecified J01.21J01.21 Acute recurrent ethmoidal sinusitis J01.3J01.3 Acute sphenoidal sinusitis J01.30J01.30 …… unspecified J01.31J01.31 Acute recurrent sphenoidal sinusitis J01.4J01.4 Acute pansinusitis J01.40J01.40 …… unspecified J01.41J01.41 Acute recurrent pansinusitis J01.8J01.8 Other acute sinusitis J01.80J01.80 Other acute sinusitis J01.81J01.81 Other acute recurrent sinusitis J01.9J01.9 Acute sinusitis, unspecified J01.90J01.90 Acute sinusitis, unspecified J01.91J01.91 Acute recurrent sinusitis, unspecified

A CUTE SINUSITIS J01 Use Additional code (B95-B97) to identify infectious agent.B95-B97 Type 1 Excludes sinusitis NOS (J32.9)J32.9 Type 2 Excludes chronic sinusitis (J32.0-J32.8)J32.0-J32.8 Includes acute abscess of sinus acute empyema of sinus acute infection of sinus acute inflammation of sinus acute suppuration of sinus

C HRONIC S INUSITIS Clinical Information: Inflammation of the paranasal sinuses that typically lasts beyond eight weeks (most references say 12 weeks). It is caused by infections, allergies, and the presence of sinus polyps or deviated septum. Signs and symptoms include headache, nasal discharge, swelling in the face, dizziness, and breathing difficulties.

C HRONIC S INUSITIS For sinusitis lasting more than 12 weeks a CT is recommended. Nasal endoscopy is also used to make a positive diagnosis. A nasal endoscopy involves inserting a flexible fiber- optic tube with a light and camera at its tip into the nose to examine the nasal passages and sinuses. This is generally painless (admittedly uncomfortable) procedure which takes between five to ten minutes to complete. A tissue sample for histology and/or cultures can also be collected and tested. Allergic fungal sinusitis (AFS) is often seen in people with asthma and nasal polyps.

S INUSITIS BY LOCATION By location (per Wikipedia) “There are several paired paranasal sinuses, including the frontal, ethmoidal, maxillary and sphenoidal sinuses. The ethmoidal sinuses is further subdivided into anterior and posterior ethmoid sinuses, the division of which is defined as the basal lamella of the middle turbinate. In addition to the severity of disease, sinusitis can be classified by the sinus cavity which it affects:ethmoidal sinuseslamellaturbinatedisease

D OCUMENT S INUSITIS BY LOCATION (W IKIPEDIA ) Maxillary SinusitisMaxillary Sinusitis – can cause pain or pressure in the maxillary (cheek) area or headache (J01.0/J32.0) FrontalFrontal – can cause pain or pressure in the frontal cavity (located above eyes), headache, particularly in the forehead (J01.1/J32.1) EthmoidalEthmoidal – can cause pain or pressure pain between/behind the eyes, the sides of the upper part of the nose, and headaches (J01.2/J32.2) SphenoidalSphenoidal – can cause pain or pressure behind the eyes, but often refers to the top of the head, or the back of the head.

D OCUMENTATION FOR B RONCHITIS SAND S INUSITIS As you can tell provider documentation will need to be concise. Document Acuity: Acute Chronic Acute on chronic

A CUTE B RONCHITIS Acute Bronchitis is an inflammation of the bronchial tubes, the airways that carry air to your lungs. It causes a cough that often brings up mucus. Shortness of breath, wheezing, and chest tightness are also symptoms. There are two main types of bronchitis, acute and chronic. The same viruses that cause colds and the flu often cause acute bronchitis. These viruses spread through the air when people cough, or through physical contact.

A CUTE & C HRONIC B RONCHITIS Being exposed to tobacco smoke, air pollution, dust, vapors, and certain fumes can cause acute and/or chronic bronchitis. Bacteria can also cause acute bronchitis, but not as often as viruses. Most cases of acute bronchitis improve within several days. But a cough can last for several weeks after the infection is gone. Inhaled medication may be needed to open airways if the patient is wheezing. Antibiotics do not work against viruses which is the most common cause of acute bronchitis. Chronic bronchitis - is defined as a productive cough that lasts for three months or more per year for at least two years. Most people with chronic bronchitis have chronic obstructive pulmonary disease (COPD

A CUTE EXACERBATION OF CHRONIC OBSTRUCTIVE BRONCHITIS AND ASTHMA Per the guidelines in chapter 10: The codes in categories J44 and J45 distinguish between uncomplicated cases and those in acute exacerbation. An acute exacerbation is a worsening or a decompensation of a chronic condition. An acute exacerbation is not equivalent to an infection superimposed on a chronic condition, though an exacerbation may be triggered by an infection

I NCLUDE NOTES WHEN REVIEWING B RONCHITIS C ODES Includes acute and subacute bronchitis (with) bronchospasm acute and subacute bronchitis (with) tracheitis acute and subacute bronchitis (with) tracheobronchitis, acute acute and subacute fibrinous bronchitis acute and subacute membranous bronchitis acute and subacute purulent bronchitis acute and subacute septic bronchitis

E XCLUDE 1 NOTE Means Not Coded Here! Type 1 Excludes bronchitis NOS (J40)J40 tracheobronchitis NOS (J40)J40

E XCLUDE II NOTE acute bronchitis with bronchiectasis (J47.0)J47.0 acute bronchitis with chronic obstructive asthma (J44.0)J44.0 acute bronchitis with chronic obstructive pulmonary disease (J44.0)J44.0 allergic bronchitis NOS (J )J bronchitis due to chemicals, fumes and vapors (J68.0)J68.0 chronic bronchitis NOS (J42)J42 chronic mucopurulent bronchitis (J41.1)J41.1 chronic obstructive bronchitis (J44.-)J44.- chronic obstructive tracheobronchitis (J44.-)J44.- chronic simple bronchitis (J41.0)J41.0 chronic tracheobronchitis (J42)J42

D ETAILED DOCUMENTATION NEEDED FOR A CUTE B RONCHITIS TO IDENTIFY SPECIFICS OF THE CONDITION : J20J20 Acute bronchitis J20.0J20.0 Acute bronchitis due to Mycoplasma pneumoniae J20.1J20.1 Acute bronchitis due to Hemophilus influenzae J20.2J20.2 Acute bronchitis due to streptococcus J20.3J20.3 Acute bronchitis due to coxsackievirus J20.4J20.4 Acute bronchitis due to parainfluenza virus J20.5J20.5 Acute bronchitis due to respiratory syncytial virus J20.6J20.6 Acute bronchitis due to rhinovirus J20.7J20.7 Acute bronchitis due to echovirus J20.8J20.8 Acute bronchitis due to other specified organisms J20.9J20.9 Acute bronchitis, unspecified

COPD ICD-10 added a code for a common acute exacerbation that brings a patient with COPD back to the provider’s office. COPD with acute lower respiratory infection such as acute bronchitis or pneumonia. The specific pneumonia or bronchitis code should be coded in addition to COPD. Documentation needs to support the code used: J44.0 Chronic obstructive pulmonary disease with acute lower respiratory infection. As with ICD-9, there is an ICD-10 code for COPD with exacerbation, which captures “decompensated” COPD, without any additional documentation. J44.1 Chronic obstructive pulmonary disease with (acute) exacerbation Replaces Obstructive chronic bronchitis with (acute) exacerbation Chronic obstructive asthma with (acute) exacerbation

COPD There is an unspecified option, which no longer confuses us about whether the COPD is predominantly asthma or predominantly bronchitis — it’s just COPD. J44.9 Chronic obstructive pulmonary disease, unspecified Replaces Obstructive chronic bronchitis without exacerbation Chronic obstructive asthma, unspecified 496 Chronic airway obstruction, not elsewhere classified

Q UESTIONS ?

R EFERENCES 2014 Family Practice Management ICD-10 data.com 2015 Children’s Healthcare of Atlanta Rhonda Butler ICD-10 3M