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 –Lungs –Bronchi –Trachea –Larynx

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

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 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 Sore throat Determine whether acute or chronic Determine whether due to infection Infections that cause pharyngitis would be coded instead of two separate codes –Specifically, coxsackievirus, flu, or streptococcus

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. 8 Bronchitis Determine whether acute or chronic Acute is classified to code 466.0 Chronic is classified to code 491 series Chronic bronchitis with other lung diseases should be researched to determine whether one or two codes are necessary

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 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

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

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 Acute and Chronic Acute conditions occur, are treated, and subside Chronic conditions are treated over long periods of time; some are lifelong

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 Pneumonia Many types Cause should be documented Documentation is key due to the types and causes

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 Types of Pneumonia Coded within ICD-9-CM Viral Pneumococcal Other bacterial Due to other specified organism In “Infectious Diseases Classified Elsewhere” Bronchopneumonia

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. 14 Category Codes 492–493 Emphysema—decrease in number of alveoli in bronchus –Category code 492 Asthma—stricture of the airway –Category code 493 –Fourth and fifth digits required

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. 15 Chronic Obstructive Pulmonary Disease COPD–496 category Decrease in airflow of lungs When combined with asthma, important to read instructional notations Fifth digit assignment

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 Status Asthmaticus Severe asthmatic attack that does not respond to treatment Documentation must support this diagnosis Sequenced first; supersedes any type of COPD including acute exacerbations

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 Other Lung Diseases Asbestosis—exposure to asbestos Empyema—infection in pleural cavity Pleurisy—inflammation of thoracic cavity Respiratory failure—severe interruption of oxygen/carbon dioxide flow