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Understanding ICD-9-CM Coding
Mary Jo Bowie MS, RHIA, RHIT
Regina Schaffer AAS, RHIA, CPC
Diseases of the
Respiratory System
CHAPTER
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Respiratory System
• Exchanges oxygen and carbon dioxide
• Structures include
– Nose/mouth: Air enters
– Lungs: Gas exchange occurs
– Bronchi: Right and Left Bronchus
– Trachea: Windpipe branches off
– Larynx: Vocal Cords or voice box
– Pharynx: Throat
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© 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.
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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
• Laboratory results are not enough to
assign a diagnostic code from this
chapter
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or posted to a publicly accessible website, in whole or in part.
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Respiratory
Infections/Diseases- 460-466
•
•
•
•
•
•
•
Common Cold (code 460)
Pharyngitis
Bronchitis
Emphysema
Sinusitis
Pneumonia
Legionnaires’ Disease
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Pharyngitis (Code 462)
•
•
•
•
Many causes (virus, bacteria, smoking)
Sore throat
Determine whether acute or chronic
Determine whether due to infection
– Infections that cause pharyngitis would be
coded instead of two separate codes
• Pharyngitis considered integral part of infection
• Specifically, coxsackievirus, flu, or
streptococcus
– If not caused by infection, 462 is used
along with other conditions.
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Coding Examples
• 8 year old with runny nose, cough, and
sore throat;
– Negative strep test
– Dx Codes: 460 and 462 (common cold
and sore throat)
• 8 year old with same symptoms;
– Positive strep test
– Dx Codes: 034.0 (Strep Throat)
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Bronchitis
• Determine whether acute or chronic
– Acute is classified to code 466.0 (short duration)
– Chronic is classified to code 491 series (last
three months and occurring two consec years)
• Chronic bronchitis with other lung diseases
should be researched to determine whether
one or two codes are necessary (acute
bronchitis with COPD – only 491.22)
• Acute Bronchitis with emphysema requires
two codes (466.0 and 492.8)
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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
– Structured are lined with the mucous
membrane connected to the sinus cavities
– Note the difference in coding ‘ACUTE’
versus Chronic Conditions
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or posted to a publicly accessible website, in whole or in part.
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Acute and Chronic
• Acute conditions occur, are treated,
and subside
• Chronic conditions are treated over long
periods of time; some are lifelong
– Examples: Chronic Sinusitis (473.9) vs
Acute Sinusitis (461)
– Abscess of tonsils (475) versus Acute
tonsillitis (4630
– Includes Chronic Laryngitis and allergic
rhinitis.
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Pneumonia and Influenza
(480-488)
• Liquid (exudate) and pus infiltrate the
lung and causes inflammation
• Many types
– Classified by organism or irritant in ICD
• Cause should be documented
• Documentation is key due to the types
and causes
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or posted to a publicly accessible website, in whole or in part.
13
Types of Pneumonia Coded
within ICD-9-CM
•
•
•
•
Viral - 480
Pneumococcal - 481
Other bacterial - 482
Due to other
specified organism483
• In “Infectious
Diseases Classified
Elsewhere”- 484
• Bronchopneumonia
– 485
• Unspecified
organism – 486
• Due to solids and
liquids – 507
• Lobar pneumonia –
481
• Legionnaire’s
Disease – 482.84
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or posted to a publicly accessible website, in whole or in part.
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Additional Coding Guidelines for
Pneumonia and Influenza
• Confirmed Cases of avian influenza or
H1N1 (swine flu) are coded by the
diagnostic statement and are coded
from category 488.
• Suspected or possible/probable avian or
swine flu are coded from category 487
NOT 488, influenza due to certain
identified influenza viruses.
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or posted to a publicly accessible website, in whole or in part.
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Category Codes 492–493
• Emphysema—decrease in number of
alveoli in bronchus resulting in loss of
lung function.
– Category code 492
• Asthma—stricture of the airway
– Category code 493
– Fourth and fifth digits required to identify
an acute disease of “status asthmaticus”
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Status Asthmaticus
• Severe asthmatic attack that does not
respond to treatment and requires
emergency care
• Documentation must support this diagnosis
• Sequenced first; supersedes any type of
COPD including acute exacerbations
• Not appropriate to code asthma code with
fifth digit 2 together with fifth digit “1” –
status asthmatics.
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or posted to a publicly accessible website, in whole or in part.
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Chronic Obstructive
Pulmonary Disease
• COPD–496 category
• Decrease in airflow of lungs
• When combined with asthma, important
to read instructional notations
• Fifth digit assignment
• Should only be used with a specific type
of COPD is not documented.
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Other Lung Diseases
• Asbestosis—exposure to asbestos
• Empyema—infection in pleural cavity
– Fourth digit depends on fistula
• Pleurisy—inflammation of
thoracic cavity (Pleura usually caused
by infection)
• Respiratory failure—severe interruption
of oxygen/carbon dioxide flow
– Acute, Chronic or acute and chronic
(518.81, 518.83, 518.84)
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or posted to a publicly accessible website, in whole or in part.
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