Chapter 10: Diseases Of The Respiratory System J 00-J99

Chapter 10 Diseases of the RespiratorySystemNovember 10, 2011Chapter 10:Diseases of the Respiratory SystemJ 00-J99 J00–J06 Acute upper respiratory infectionsJ10–J18 Influenza and pneumoniaJ20–J22 Other acute lower respiratory infectionsJ30–J39 Other diseases of upper respiratory tractJ40–J47 Chronic lower respiratory diseasesJ60–J70 Lung diseases due to external agentsJ80–J84 Other respiratory diseases principallyaffecting the interstitiumJ85–J86 Suppurative and necrotic conditions ofthe lower respiratory tractJ90–J94 Other diseases of the pleuraJ95Intraoperative and postproceduralcomplications and disorders of respiratorysystem, not elsewhere classifiedJ96–J99 Other diseases of respiratory system2Cypress College HIT ProgramPage 1 of 91

Chapter 10 Diseases of the RespiratorySystem November 10, 201110.a. Chronic Obstructive Pulmonary Diseaseand Asthma 1) Acute exacerbation of COPD 10.b. Acute Respiratory Failure 1) ARF as PDX 2) ARF as secondary diagnosis 3) Sequencing of ARF and another acute condition 10.c. Influenza due to certain identified influenzaviruses10.d. Ventilator associated Pneumonia 1) Documentation of Ventilator Associated Pneumonia 2) Ventilator associated Pneumonia develops afteradmission3 Whena respiratory condition isdescribed as occurring in morethan one site and is notspecifically indexed, it should beclassified to the lower anatomicsite (for example, tracheobronchitis tobronchitis in J40)4Cypress College HIT ProgramPage 2 of 92

Chapter 10 Diseases of the RespiratorySystemNovember 10, 2011 Useadditional code, whereapplicable, to identify: Exposure to environmental tobaccosmoke (Z58.7) Exposure to tobacco smoke in theperinatal period (P96.81) History of tobacco use (Z86.82) Occupational exposure toenvironmental tobacco smoke(Z57.31) Tobacco dependence (F17.–) Tobacco use (Z72.0)5 Read Includes NoteCode also type of asthma if applicableUse additional code for exposures Examine Excludes 1 noteJ44.0 COPD with acute lower respiratoryinfection Use additional code to identify infection J44.1 COPD with (acute) exacerbation Excludes 2 COPD with acute bronchitis (J44.0) J44.9 COPD unspecified6Cypress College HIT ProgramPage 3 of 93

Chapter 10 Diseases of the RespiratorySystemNovember 10, 2011J45.2 Mild intermittent asthma J45.3Mild persistent asthma J45.4Moderate persistent asthma J45.5Severe persistent asthma J45.9Other and unspecified asthmath 5 Character: Uncomplicated With (acute) exacerbation With Status Asthmaticus Review Excludes 2 Note7 Newsection in every chapter Fourth characters describe complicationsfollowingx hemorrhage, hematoma, accidentalpuncture, and so on. Fifth characters further specify thelisted complication. Sixth character adds additionalspecificity8Cypress College HIT ProgramPage 4 of 94

Chapter 10 Diseases of the RespiratorySystemNovember 10, 20111. Acute Bronchitis with COPD2. Acute viral pneumonia;right sided hemiparesis due to old CVA five years prior toadmission. Patient is left handed3. Allergic (house dust) bronchial asthma in acuteexacerbation with status asthmaticus. Patient was admittedwith intractable wheezing unresponsive to Proventil orPrednisone. Wheezing subsided after infusions ofsubcutaneous epinephrine and IV theophylline4. A known CHF (chronic systolic failure) was admitted fromSNF in acute respiratory failure. The patient was intubatedand remained on continuous mechanical ventilation for 2days. Diagnosis: ARF, CHF95. A casual drug user found unresponsive in his homeby friends was brought in by paramedics to theCenter’s ED in acute respiratory failure & placed oncontinuous positive airway pressure ventilation for oneday.Discharge Diagnosis: Acute respiratory failuresecondary to accidental crack cocaine overdose athome.6. Proteus mirabilis pneumonia with shortness ofbreath and pulmonary infiltrates; Bronchoscopy withtransbronchial biopsy of lung to rule out cancer.7. Severe persistent asthma with acute exacerbation10Cypress College HIT ProgramPage 5 of 95

Chapter 10 Diseases of the RespiratorySystemNovember 10, 2011 NoWebinar in December andJanuary Will resume February 16, 2012 Any special requests? CCSExam Review March 10 & March 11, 2012 CCSExams for March 2013 basedon ICD 10 CM & ICD 10-PCS1112Cypress College HIT ProgramPage 6 of 96

care of an initial AMI, and the reason for admission is thesubsequent AMI, the I22 code should be sequenced firstfollowed by the I21. An I21 code must accompany an I22 codeto identify the site of the initial AMI, and to indicate that thepatient is still within the 4 week time frame of healing from theinitial AMI.The guidelines for assigning the correct I22 code are the sameas for the initial AMI.10.Chapter 10: Diseases of Respiratory System (J00-J99)a.Chronic Obstructive Pulmonary Disease [COPD] andAsthma1)Acute exacerbation of chronic obstructive bronchitisand asthmaThe codes in categories J44 and J45 distinguish betweenuncomplicated cases and those in acute exacerbation. An acuteexacerbation is a worsening or a decompensation of a chroniccondition. An acute exacerbation is not equivalent to aninfection superimposed on a chronic condition, though anexacerbation may be triggered by an infection.b.Acute Respiratory Failure1)Acute respiratory failure as principal diagnosisA code from subcategory J96.0, Acute respiratory failure, orsubcategory J96.2, Acute and chronic respiratory failure, maybe assigned as a principal diagnosis when it is the conditionestablished after study to be chiefly responsible for occasioningthe admission to the hospital, and the selection is supported bythe Alphabetic Index and Tabular List. However, chapterspecific coding guidelines (such as obstetrics, poisoning, HIV,newborn) that provide sequencing direction take precedence.2)Acute respiratory failure as secondary diagnosisRespiratory failure may be listed as a secondary diagnosis if itoccurs after admission, or if it is present on admission, but doesnot meet the definition of principal diagnosis.Page 7 of 9

3)Sequencing of acute respiratory failure and anotheracute conditionWhen a patient is admitted with respiratory failure and anotheracute condition, (e.g., myocardial infarction, cerebrovascularaccident, aspiration pneumonia), the principal diagnosis willnot be the same in every situation. This applies whether theother acute condition is a respiratory or nonrespiratorycondition. Selection of the principal diagnosis will bedependent on the circumstances of admission. If both therespiratory failure and the other acute condition are equallyresponsible for occasioning the admission to the hospital, andthere are no chapter-specific sequencing rules, the guidelineregarding two or more diagnoses that equally meet thedefinition for principal diagnosis (Section II, C.) may beapplied in these situations.If the documentation is not clear as to whether acute respiratoryfailure and another condition are equally responsible foroccasioning the admission, query the provider for clarification.c.Influenza due to certain identified influenza influenzavirusesCode only confirmed cases of avian influenza (code J09.0-,Influenza due to identified avian influenza virus) or novelH1N1 or swine flu, code J09.1-. This is an exception to thehospital inpatient guideline Section II, H. (UncertainDiagnosis).In this context, “confirmation” does not require documentationof positive laboratory testing specific for avian or novel H1N1(H1N1 or swine flu) influenza. However, coding should bebased on the provider’s diagnostic statement that the patienthas avian influenza.If the provider records “suspected or possible or probable avianinfluenza,” the appropriate influenza code from category J11,Influenza due to unspecified influenza virus, should beassigned. A code from category J09, Influenza due to certainidentified influenza viruses, should not be assigned.Page 8 of 9

d.Ventilator associated Pneumonia1)Documentation of Ventilator associated PneumoniaAs with all procedural or postprocedural complications,code assignment is based on the provider’s documentationof the relationship between the condition and theprocedure.Code J95.851, Ventilator associated pneumonia, should beassigned only when the provider has documented ventilatorassociated pneumonia (VAP). An additional code toidentify the organism (e.g., Pseudomonas aeruginosa, codeB96.5) should also be assigned. Do not assign an additionalcode from categories J12-J18 to identify the type ofpneumonia.Code J95.851 should not be assigned for cases where thepatient has pneumonia and is on a mechanical ventilatorbut the provider has not specifically stated that thepneumonia is ventilator-associated pneumonia. If thedocumentation is unclear as to whether the patient has apneumonia that is a complication attributable to themechanical ventilator, query the provider.2)Ventilator associated Pneumonia Develops afterAdmissionA patient may be admitted with one type of pneumonia(e.g., code J13, Pneumonia due to Streptococcuspneumonia) and subsequently develop VAP. In thisinstance, the principal diagnosis would be the appropriatecode from categories J12-J18 for the pneumonia diagnosedat the time of admission. Code J95.851, Ventilatorassociated pneumonia, would be assigned as an additionaldiagnosis when the provider has also documented thepresence of ventilator associated pneumonia.11.Chapter 11: Diseases of Digestive System (K00-K94)Reserved for future guideline expansionPage 9 of 9

b. Acute Respiratory Failure 1) Acute respiratory failure as principal diagnosis A code from subcategory J96.0, Acute respiratory failure, or subcategory J96.2, Acute and chronic respiratory failure, may be assigned as a principal diagno