Today we're going to talk about ICD-10-CM
Chapter 10 the Diseases of the
Respiratory System, 2017 guidelines.
There are instructional notes
at the beginning of Chapter 10 that we
need to pay attention to. The first one says
When respiratory condition is described
as occurring in more than one site and
is not specifically indexed it should be
classified to the lower anatomic site
and the example that's given to us is
tracheobronchitis. If you think of
your anatomy, the trachea is above the
bronchus, which the bronchus (bronchi) are
associated with the lungs, the bronchi
are associated with the lungs then you
would code to this condition of tracheobronchitis
you would code it to bronchitis.
Tthere is no index or no code specific to
tracheobronchitis. We're also given
instructional notes to "use an additional
codes where applicable to identify
exposure to environmental smoke, exposure
to smoke in the perinatal period, a
history of tobacco dependence,
occupational exposure to environmental
smoke, or you're working in an
environment where you're having
exposure to smoke, tobacco dependence and
tobacco use. They are differentiated. This
is an instructional note at the beginning
of the Chapter so you're not going to
find this instructional note with other
codes in this Chapter. You would have to
remember that always when you're coding
in the Respiratory Chapter,you're going
to have to add these codes to indicate
if there's any exposure to tobacco smoke or
if there's a patient with tobacco
dependence or history of tobacco
dependence or tobacco use. The first
guideline has to do with acute
exacerbation of chronic obstructive bronchitis and asthma.
It does cover both
conditions and our first one we're
looking at is just the bronchitis where
the patient has a diagnosis of acute
streptococcal bronchitis with acute
exacerbation of COPD. There's the index
pathway for those two conditions. You
notice that there are codes that are
different for the COPD with acute
bronchitis and the COPD with exacerbation.
This it's the same guideline
but now we're talking about asthma,
exacerbation of moderate persistent
asthma with status asthmaticus. There's
your index pathway and the rationale. You
notice the J45 category, the 5th
character is what's going to distinguish
between uncomplicated cases,
acute exacerbation, or status
asthmaticus. Status asthmaticus is the
most serious of those three. The next
guideline, acute respiratory failure as a
principal diagnosis. The codes for acute
and chronic respiratory failure can be
assigned as the principal when it is the
condition established after study to
be chiefly responsible for occasioning
the admission to the hospital and the
selection is supported by the Index in
the Tabular. By "supported by", it's talking
about those instructional notes. As long
as you're following the logic behind
the instructional notes, you'd be fine.
You have to remember that the Chapter
Specific Coding Guidelines, specifically
OB, poisoning, HIV ,the newborn chapter,
they provide sequencing direction and
their sequencing direction would take
precedence over you deciding if this
acute respiratory failure should be a
principal. So you're always reading the
guidelines for whatever your patient has
wrong with them. If in this case it would have
been given the acute hypoxic respiratory
failure is listed as the principal
diagnosis and the COPD with exacerbation
would be your secondary diagnosis,
Sometimes you can tell what the
principal should be based upon your
documentation; other times you have to
ask the physician what he or she thinks.
Always, before you query a physician, if
you're working as a coder, get directions
from your supervisor to
be sure that you're following what the
standard of practice is in your facility.
Acute respiratory failure as a secondary
diagnosis- this is when you would use it
in those cases where the sequencing
tells us what to do. In a case of
poisoning, that is going to be your
principal diagnosis and the acute
respiratory failure is going to be your
secondary. The poisoning code (T40.2x1AA)
takes precedence. It is the principal
diagnosis. The poisoning codes are in
Chapter 19so we will get to
those guidelines later. It's just an
example of where you are going to code
the respiratory failure but it's not
going to be your principal diagnosis.
Next guideline has to do with the
sequencing of acute respiratory failure
and another acute condition. In this case,
the patient has acute pneumococcal
pneumonia and acute respiratory failure,
both present on admission so if it
wasn't clear which one would be the
principal (diagnosis). You might query your physician
but the way we have it listed here, we're
going to take the respiratory failure as
our principal diagnosis and the
pneumonia, the pneumococcal pneumonia (J13)
category as our secondary diagnosis.
There are not very many three character
codes in ICD-10-CM. J13 is one of those.
This guideline has to do with influenza
due to certain identified influenza
viruses. You may remember from other
podcasts that there are times we code
only "confirmed" cases. HIV is one of those.
Zika is another and here is a third
that we're going to be talking about,
Influenza due to identified novel influenza
A virus. Only confirmed cases of this
type of virus are coded
and then I go into some of the rationale
here on the right. Be sure that you are,
when you're reviewing these podcasts,
really reading through the rationale. I
don't put it there for my benefit. I put
it there for your benefit so you
understand where the thinking is for why
you would choose that code. The next code
is ventilator-associated pneumonia
developing after admission where the
patient is coming in with pneumonia due to
Klebsiella and then develops the
superimposed ventilator-associated
pneumonia caused by MRSA. MRSA, you
may recall, is methicillin-resistant
Staph aureus. Here's your pathway on the
right and then I have the rationale. If you
any questions about Chapter 10's coding
guidelines, please post them in the
discussion board. I'll do my best to
answer them. Thank you so much and have a good day.