1. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. THE COMPLETE DIAGNOSIS CODING SOLUTION THIRD EDITION Chapter 13 Coding Respiratory Conditions 13-1

2. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Learning Outcomes 13.1 Identify the components of the respiratory system. 13.2 Discern the various underlying causes of respiratory disorders. 13.3 Accurately code any involvement of tobacco in the patient’s respiratory disorder. 13-2

3. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Learning Outcomes (cont.) 13.4 Determine the details needed to code pneumonia and influenza correctly. 13.5 Accurately code chronic obstructive pulmonary disease (COPD) diagnoses and manifestations. 13.6 Determine the appropriate use of external codes when applicable to respiratory conditions. 13-3

4. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Key Terms Alveolar sac Bronchi Bronchioles Chronic obstructive pulmonary disease (COPD) Diaphragm 13-4

5. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Key Terms (cont.) Epiglottis Exacerbation Expiration Influenza Inspiration 13-5

6. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Key Terms (cont.) Larynx Lungs Nasal septum Paranasal sinuses Pleura 13-6

7. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Key Terms (cont.) Pneumonia Pneumothorax Respiration Respiratory disorder Status asthmaticus Trachea 13-7

8. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Introduction The respiratory system begins with the nose and continues down the windpipe to the lungs and the bronchi. Respiration, or breathing, consists of inspiration (bringing oxygen into the body and delivering it into the circulatory system) and expiration (getting rid of carbon dioxide). 13-8

9. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Anatomy of the Respiratory System The upper respiratory system includes: Nose Nasal cavity Nasal conchae Paranasal sinuses Internal nares Nasopharynx Pharynx Learning Outcome: 13.1 13-9

10. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Anatomy of the Respiratory System (cont.) The lower respiratory system includes: Larynx Trachea Bronchi Lungs Bronchioles Alveoli Learning Outcome: 13.1 13-10

11. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Respiratory Disorders Respiratory disorders can have many causes. Having difficulty bringing oxygen into the lungs and getting carbon dioxide out of the body can interfere with the patient’s quality of life. Learning Outcome: 13.2 13-11

12. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Underlying Causes of Respiratory Disorders Causes can include: Congenital anomalies Genetic disorders Manifestations of another disease Trauma Environment Lung infections Lifestyle behaviors Learning Outcome: 13.2 13-12

13. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Tobacco Involvement Reporting tobacco use, abuse, and/or dependence is required. The start of ICD-10-CM Chapter 10, Diseases of the respiratory system (J00– J99) includes a notation that applies to all codes within this chapter. Learning Outcome: 13.3 13-13

14. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Tobacco Involvement (cont.) Use additional code, where applicable, to identify: Exposure to environmental tobacco smoke (Z77.22) Exposure to tobacco smoke in the perinatal period (P96.81) History of tobacco use (Z87.891) Learning Outcome: 13.3 13-14

15. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Tobacco Involvement (cont.) Use additional code, where applicable, to identify (cont): Occupational exposure to environmental tobacco smoke (Z57.31) Tobacco dependence (F17.-) Tobacco use (Z72.0) Learning Outcome: 13.3 13-15

16. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Tobacco Involvement (cont.) Exposure: the patient has been in contact with a source of tobacco smoke that may impact the patient. Use: the patient smokes tobacco on a regular basis with no obvious clinical manifestations. Learning Outcome: 13.3 13-16

17. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Tobacco Involvement (cont.) Abuse: the patient habitually smokes tobacco. Clinical manifestations are evident. Dependence: compulsive, continuous smoking of tobacco has resulted in significant clinical manifestations as well as physiological need. History: describes a patient who has successfully quit using tobacco products. Learning Outcome: 13.3 13-17

18. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Diagnostic Testing Testing for respiratory conditions may include: –x-ray –computed tomography (CT) scan –magnetic resonance angiography (MRA) –positron emission tomography (PET) –ultrasound Learning Outcome: 13.3 13-18

19. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Pleural Disorders Pleura is made up of two membranes: the visceral pleura and the parietal pleura. Pleurisy (pleuritis)—inflammation on one or both of the pleural membranes. Pleural effusion—excess fluid in the pleural cavity, frequently a manifestation of congestive heart failure. Learning Outcome: 13.3 13-19

20. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Pleural Disorders (cont.) Pneumothorax—excess air or gases in the pleural space, typically caused by COPD or TB. Hemothorax—accumulation of blood in the pleural cavity, most often caused by an injury to the chest. Learning Outcome: 13.3 13-20

21. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Pulmonary Embolism An embolus gets stuck within the lungs and blocks the flow of blood. Can result in permanent lung damage or death. Learning Outcome: 13.3 13-21

22. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Infectious Respiratory Diseases Respiratory syncytial virus (RSV) infections Pulmonary fibrosis –Creation of extra fibrous tissue (scar tissue) in response to inflammation or irritation in the lungs –May be caused by another disease or as a side effect of certain medications Learning Outcome: 13.3 13-22

23. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Pneumonia and Influenza Pneumonia—a serious infection of the lung tissue; typically hinders the exchange of gases. It is important to know the type of pneumonia for accurate coding. –Viral –Bacterial –Protozoan Learning Outcome: 13.4 13-23

24. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Pneumonia and Influenza (cont.) Influenza—an acute infection of the respiratory tract caused by the influenza virus. Commonly known as the flu or grippe. Must know what virus is involved to code correctly. Learning Outcome: 13.4 13-24

25. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Pneumonia and Influenza (cont.) Pneumonia as a Manifestation of HIV If the notes report that the patient has HIV-positive status, you have to include: –B20 Human immunodeficiency virus (HIV) disease Code B20 should be listed first, followed by the appropriate pneumonia code. Learning Outcome: 13.4 13-25

26. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Chronic Obstructive Pulmonary Disease (COPD) One of the most common respiratory disorders Distinguished by restricted airflow Three types Chronic bronchitis Emphysema Asthma Learning Outcome: 13.5 13-26

27. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Chronic Obstructive Pulmonary Disease (cont.) Exacerbation: an increase in the severity of a disease or its symptoms Status asthmaticus: The condition of asthma that is life-threatening and does not respond to therapeutic treatments Learning Outcome: 13.5 13-27

28. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Respiratory Conditions Requiring External Cause Codes External cause codes are required when respiratory conditions are caused by trauma or environmental factors. External cause codes must be reported to explain HOW and WHERE. –J67 Farmers’ lung might need an external cause code for a workers’ compensation claim. Learning Outcome: 13.6 13-28

29. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Respiratory Failure Identifies that a patient’s lungs are not working efficiently. Code choices include: –J96.0- Acute respiratory failure –J96.1- Chronic respiratory failure –J96.2- Acute and chronic respiratory failure Learning Outcome: 13.6 13-29

30. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Ventilator-Associated Pneumonia Ventilator: a machine that will, essentially, complete respiration. Pathogens can travel directly into the patient’s lungs, potentially causing ventilator-associated pneumonia (VAP). Attending physician must specifically document diagnosis of VAP before you can report code J95.851. Learning Outcome: 13.6 13-30

31. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Ventilator-Associated Pneumonia (cont.) Beneath this code is a use additional code notation. Report a second code to identify the specific organism responsible for this infection. Learning Outcome: 13.6 13-31

32. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Chapter Summary Sadly, most people take breathing for granted until they cannot do it without difficulty or pain. You have to know how to code respiratory conditions accurately whether you are working for a family physician, a pediatrician, or a pulmonologist. 13-32