Today we're looking at Chapter 19, Diseases of the Respiratory System.
And this corresponds to Chapter 10 in the ICD-10-CM code book.
As always, we're going to skip over that procedure coding and focus on the diagnostic portions.
Just for some reminders, the coder cannot assume there is a respiratory infection based
upon a lab report.
You have to look for the physician documentation.
Nor can you assume a lab report must be positive for a patient to have an infection.
If the doctor has started antibiotics before the lab test was completed, that infection
is not going to show up.
So, bottom line, rely on the physician.
You should only code for avian influenza or other novel influenza A if the case is confirmed.
This is an exception to the inpatient coding guidelines.
Atelectasis, the collapse of lung tissue, is an integral part of pulmonary disease,
therefor we do not code it.
Respiratory failure, always due to an underlying condition, therefore it's important to be
sure that the principle diagnosis and the secondary diagnosis are properly assigned.
Acute pulmonary edema can be related to heart failure.
In that case it's cardiogenic or it can occur in the absence of heart failure or other heart
disease and therefore be noncardiogenic.
For this first exercise, 19.1 #4, the couple of things I wanted to say, one is that
I have never used this code for an unspecified infectious disease.
Most of the time we know what the organism is and we're able to code that infection.
But this code exists because I'm sure there're times that we don't know that.
For the pneumonia code, J17, I want to bring to your attention a couple of things.
There is a code first note there that doesn't apply to us, and a long list of Excludes 1
diagnoses to review.
We should always review the instructional notes, the Excludes 1 and the Excludes 2 notes
just in case it does apply to us.
So let's look at that.
For J17 we can see here, code first underlying disease is here.
Those don't apply to us.
But look at all this Excludes 1 possibilities.
We really should review all of those to be sure that this code is the correct code.
The other thing I wanted you to notice is that this is covered by the general coding
guideline for etiology and manifestation.
This infection B99 is our etiology code, and the J17 is the manifestation code, how the
infection is being manifested in the body.
Exercise 19.1 #9, this relates to an aids coding guideline which takes us back
to chapter 1.
But this is the guideline.
If a patient is admitted for an HIV related condition, the principal (diagnosis) is going to be B20.
So that guideline tells you what that principal (diagnosis) is going to be.
That will be your first listed code.
And then B59 is the plasma cell pneumonia.
I would also make a note in your code book or in your notes somewhere that plasma cell
could also be called pneumocystosis or the pneumonia caused by the pneumocystis carinii.
Exercise 19.2 #3, acute exacerbation of a chronic asthmatic bronchitis.
Our main term is bronchitis.
And when we look, we follow our pathway here we get to J44.1.
And when we go to this code we see an instructional note to code also the type of asthma.
And when we look that up, we get J45.901.
19.3 #7, acute respiratory failure due to intracerebral hemorrhage.
I showed you my pathways here, And you see the first time you look it up it takes you
to a different path, hemorrhage-intracranial intracerebral.
And then when you go here you get to I61.9.
And there is an instructional note under this category, but it doesn't apply to us.
I just want to bring to your attention to always look for those.
Then there's the respiratory failure here.
There're three coding guidelines related to acute respiratory failure.
And in the real world, I have a note, the coder would need additional information to
know which diagnosis should be the principle.
If the acute respiratory failure was the reason why you were admitted, then that would be
the J96 code first, and if the intracerebral hemorrhage was the reason for the admission,
then it would be I61.9.
This does not give us very much information to make that call.
So I'm just bringing to your attention that if you're a coder in the real world, you would
not be relying on this one liner.
You would have an entire medical record to review to help you know which is the correct
principle diagnosis.
Exercise 19.3 #9, chronic chemical bronchitis due to accidental inhalation of chlorine fumes
2 years ago.
First of all, you're going to notice that this is a sequela, two years ago.
So many of our T codes and S codes have a seventh character indicating the encounter.
This particular one, if you go the the Table of Drugs and Chemicals, substance chlorine
gas, and then look in the "Poisoning, accidental" column you get this code with the seventh
character S for the encounter which is the sequela.
Then here's your bronchitis code due to fumes or vapors, chronic.
And you see when you look up your J68.4 code there is a code first, the T code to identify
the cause.
That helps us know how to sequence these.
And then there's an additional code to identify any associated respiratory conditions such
as respiratory failure.
That's not talked about in this scenario.
So we would only code that T code for the accidental poisoning and then the chronic
chemical bronchitis.
There is a guideline, acute respiratory failure as a secondary diagnosis, which you would
need to review.
Exercise 19.3 number 11, admitted in acute respiratory failure due to acute exacerbation
of chronic obstructive bronchitis.
Here's our path for our acute respiratory failure, and our bronchitis.
And I want to show you, when you go this path through bronchitis you get a .9 which is a
very unspecific code.
So whenever possible you want to code more specificity.
So if we start with disease, because we know that chronic obstructive disease is a pulmonary
disease, and if we go this path instead,
disease-pulmonary-chronic obstructive-with-exacerbation acute J44.1,
a much more specific code, and the correct code.
In the guideline is acute respiratory failure as a principle diagnosis.
But again, I'm bringing to your attention that if you were working in the real world
you would be reviewing the entire medical record.
You couldn't rely on one line in this case to know which of those diagnosis should be the principle.
Exercise 19.3 #12, acute tracheobronchitis due to respiratory syncytial virus infection.
And I put a little blurb here from the Internet to describe to you what "RSV" is.
And you'll notice when you start looking up at the code there are codes for fifteen years
of age and older, and the younger children.
Obviously, this is an older person and we're going to code it this way, bronchitis acute
due to virus respiratory syncytial, J20.5.
Don't forget to read those Excludes 1 and Excludes 2 notes under these codes.
19.3 #16, an infected tracheotomy due to staphylococcal abscess of the neck.
I have the page number here in the Coding Handbook because this one comes after some
discussion about procedures.
So I want to be sure you're not missing this, because this is a diagnosis code, not a procedure code.
The tracheotomy would be a procedure code.
But the complications related to the tracheotomy are diagnosis codes.
So it comes under complication-tracheotomy-infection, and we have an instructional note to "use
additional code to identify the type of infection".
Then we look up our abscess of the neck, and we see that for the category of infections
of the skin and subcutaneous tissues in this category, there is a "use additional code to identify
the infectious agent".
So we look up our B95.8 code, staphylococcal as a cause of disease.
So this is your pathway to help you get there.
But I want to be sure you don't miss this tracheotomy complications in the coding handbook.
Now let's look at some longer exercises that are not in the Coding Handbook.
As I've mentioned in previous podcasts, we're going to start looking at longer scenarios
so you're having to search for main terms and just get used to being able to read quickly
through the medical record documentation and knowing which diagnosis you need to code.
The physicians diagnostic statement: 15 year old child is diagnosed with influenza due
to novel influenza A with GI manifestations.
Reminder: if the physician had stated 'suspected' novel influenza A, it would be coded differently.
Novel influenza A is also known as bird flu, in case you've ever heard that term.
So I have the pathway here.
And you see in this case it is a combination code because you've got the infection, the
influenza, and the manifestation, the GI, and the same code, J09.x3.
And there is a guideline specifically related to these novel influenza where you code only
confirmed cases.
And this is an exception to the hospital inpatient guideline.
And if the physician had stated suspected novel influenza A, a code from J11 would be
chosen instead of the J09.