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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 13 Respiratory System • Exchanges oxygen and carbon dioxide • Structures include – Nose/mouth – Lungs – Bronchi – Trachea – Larynx © 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 © 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 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 © 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. 5 Respiratory Infections/Diseases • • • • • • Pharyngitis Bronchitis Emphysema Sinusitis Pneumonia Legionnaires’ Disease © 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 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 © 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 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 © 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 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 © 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 © 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 Acute and Chronic • Acute conditions occur, are treated, and subside • Chronic conditions are treated over long periods of time; some are lifelong © 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 Pneumonia • Many types • Cause should be documented • Documentation is key due to the types and causes © 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 Types of Pneumonia Coded within ICD-9-CM • • • • • Viral Pneumococcal Other bacterial Due to other specified organism In “Infectious Diseases Classified Elsewhere” • Bronchopneumonia © 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 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 © 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 Chronic Obstructive Pulmonary Disease • COPD–496 category • Decrease in airflow of lungs • When combined with asthma, important to read instructional notations • Fifth digit assignment © 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 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 © 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 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 © 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