1. Understanding ICD-9-CM Coding Mary Jo Bowie MS, RHIA, RHIT Regina Schaffer AAS, RHIA, CPC

2. CHAPTER 13 Diseases of the Respiratory System

3. © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 3 Respiratory System Exchanges oxygen and carbon dioxide Structures include –Nose/mouth: Air enters –Lungs: Gas exchange occurs –Bronchi: Right and Left Bronchus –Trachea: Windpipe branches off –Larynx: Vocal Cords or voice box –Pharynx: Throat

4. © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 4

5. 5 Coding for Respiratory System 460–519 category codes Neoplastic disease and some major infectious diseases are found in other chapters of ICD-9-CM Provider documentation guides code assignment Laboratory results are not enough to assign a diagnostic code from this chapter

6. © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 6 Respiratory Infections/Diseases- 460-466 Common Cold (code 460) Pharyngitis Bronchitis Emphysema Sinusitis Pneumonia Legionnaires’ Disease

7. © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 7 Pharyngitis (Code 462) Many causes (virus, bacteria, smoking) Sore throat Determine whether acute or chronic Determine whether due to infection –Infections that cause pharyngitis would be coded instead of two separate codes Pharyngitis considered integral part of infection Specifically, coxsackievirus, flu, or streptococcus –If not caused by infection, 462 is used along with other conditions.

8. © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Coding Examples 8 year old with runny nose, cough, and sore throat; –Negative strep test –Dx Codes: 460 and 462 (common cold and sore throat) 8 year old with same symptoms; –Positive strep test –Dx Codes: 034.0 (Strep Throat) 8

9. © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 9 Bronchitis Determine whether acute or chronic –Acute is classified to code 466.0 (short duration) –Chronic is classified to code 491 series (last three months and occurring two consec years) Chronic bronchitis with other lung diseases should be researched to determine whether one or two codes are necessary (acute bronchitis with COPD – only 491.22) Acute Bronchitis with emphysema requires two codes (466.0 and 492.8)

10. © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 10 Other Diseases of the Upper Respiratory Tract Category codes 470–478 Chronic inflammatory diseases –Conditions that affect accessory structures of the respiratory system, such as sinus cavities and middle ear –Structured are lined with the mucous membrane connected to the sinus cavities –Note the difference in coding ‘ACUTE’ versus Chronic Conditions

11. © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 11

12. © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 12 Acute and Chronic Acute conditions occur, are treated, and subside Chronic conditions are treated over long periods of time; some are lifelong –Examples: Chronic Sinusitis (473.9) vs Acute Sinusitis (461) –Abscess of tonsils (475) versus Acute tonsillitis (4630 –Includes Chronic Laryngitis and allergic rhinitis.

13. © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 13 Pneumonia and Influenza (480-488) Liquid (exudate) and pus infiltrate the lung and causes inflammation Many types –Classified by organism or irritant in ICD Cause should be documented Documentation is key due to the types and causes

14. © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Types of Pneumonia Coded within ICD-9-CM Viral - 480 Pneumococcal - 481 Other bacterial - 482 Due to other specified organism- 483 In “Infectious Diseases Classified Elsewhere”- 484 Bronchopneumonia – 485 Unspecified organism – 486 Due to solids and liquids – 507 Lobar pneumonia – 481 Legionnaire’s Disease – 482.84 14

15. © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Additional Coding Guidelines for Pneumonia and Influenza Confirmed Cases of avian influenza or H1N1 (swine flu) are coded by the diagnostic statement and are coded from category 488. Suspected or possible/probable avian or swine flu are coded from category 487 NOT 488, influenza due to certain identified influenza viruses. 15

16. © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 16 Category Codes 492–493 Emphysema—decrease in number of alveoli in bronchus resulting in loss of lung function. –Category code 492 Asthma—stricture of the airway –Category code 493 –Fourth and fifth digits required to identify an acute disease of “status asthmaticus”

17. © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 17 Status Asthmaticus Severe asthmatic attack that does not respond to treatment and requires emergency care Documentation must support this diagnosis Sequenced first; supersedes any type of COPD including acute exacerbations Not appropriate to code asthma code with fifth digit 2 together with fifth digit “1” – status asthmatics.

18. © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 18 Chronic Obstructive Pulmonary Disease COPD–496 category Decrease in airflow of lungs When combined with asthma, important to read instructional notations Fifth digit assignment Should only be used with a specific type of COPD is not documented.

19. © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 19 Other Lung Diseases Asbestosis—exposure to asbestos Empyema—infection in pleural cavity –Fourth digit depends on fistula Pleurisy—inflammation of thoracic cavity (Pleura usually caused by infection) Respiratory failure—severe interruption of oxygen/carbon dioxide flow –Acute, Chronic or acute and chronic (518.81, 518.83, 518.84)