Part 4: Top 5 ICD-10-CM Chapters 2019

In 2019, HIA reviewed over 725,600 ICD-10-CM codes from many different facilities including reviews on our own coders. Yesterday we looked at the ICD-10-CM Chapter 9 and today we will focus on the fourth area with the most coding opportunities found during HIA reviews.

1. Z00-Z99—Factors influencing health status and contact with health services
2. A00-B99—Certain Infectious and Parasitic Diseases
3. I00-I99—Disease of the Circulatory System
4. J00-J99—Diseases of the Respiratory System
5. E00-E89—Endocrine, Nutritional, and Metabolic Diseases

For Part 4 of this 5-part series, we will look at Chapter 10 within ICD-10-CM—J00-J99—Diseases of the Respiratory System. There is no possible way to include every guideline or coding reference for this chapter, but here are some of the most common issues.

Chapter 10: J00-J99—Diseases of the Respiratory System:

Chapter 10 in ICD-10-CM has 11 sections. In looking through the recommendations made, it looks like sequencing of the PDX and specificity are the most common recommendations, followed by additions and deletions. This chapter covers acute respiratory infections and conditions as well as chronic respiratory diseases. Below are a few areas where coding opportunities were identified during HIA client and internal quality reviews.

• Sequencing of pneumonia or determining if pneumonia was ruled in/out
• Queries to clarify the clinical significance or clinical indicators for pneumonia and acute respiratory failure
• Re-sequencing of acute respiratory failure
• Re-sequencing of COPD diagnoses
• Further specificity on type of pneumonia or organism responsible
• Reporting a poisoning as PDX when due to drugs or other external causes/agents
• Reporting a new PDX from another chapter within ICD-10-CM such as from Chapter 1
• Querying to clarify if the condition is a postprocedural complication
• Not following the latest guidelines on sequencing when patient presents with COPD exacerbation and pneumonia
• Pneumonia being ruled out in the body of the record or diagnosis dropped without documented reason
• Multiple missed opportunities

In addition to the Official Coding Guidelines for ICD-10-CM for FY 2020, Pages 52-55 that address specific chapter guidelines to follow for reporting diseases of the respiratory system, there are multiple AHA Coding Clinics that discuss some of these in detail. Here are a few of these:

• ICD-10-CM/PCS Coding Clinic, Third Quarter 2016 Pages: 10-11, 14-16
• ICD-10-CM/PCS Coding Clinic, Fourth Quarter 2017 Pages: 96-98
• ICD-10-CM/PCS Coding Clinic, First Quarter 2019 Pages: 34-37
• ICD-10-CM/PCS Coding Clinic, Second Quarter 2019 Pages: 6-7, 28, 31-32
• ICD-10-CM/PCS Coding Clinic, First Quarter 2017 Pages: 24-27
• ICD-10-CM/PCS Coding Clinic, Second Quarter 2015 Pages: 15-16
• ICD-10-CM/PCS Coding Clinic, Fourth Quarter 2016 Pages: 9-10
• ICD-10-CM/PCS Coding Clinic, Fourth Quarter 2013 Page: 121
• ICD-10-CM/PCS Coding Clinic, First Quarter 2016 Page: 38
• ICD-10-CM/PCS Coding Clinic, First Quarter 2015 Page: 21
• ICD-10-CM/PCS Coding Clinic, Third Quarter 2019 Page: 37
• ICD-10-CM/PCS Coding Clinic, Third Quarter 2018 Pages: 24-25
• ICD-10-CM/PCS Coding Clinic, Third Quarter 2014 Page: 4

Coding Tips for Chapter 10: J00-J99-Diseases of the Respiratory System:

• Follow all instructional notes within ICD-10-CM for sequencing and to determine if additional codes would be reported
• Exacerbation/decompensation is a worsening of a chronic condition
• Acute respiratory failure is a life-threatening condition may be the PDX if the focus of treatment is towards the failure (such as BiPAP or mechanical ventilation) unless there are chapter-specific guidelines that direct otherwise (such as obstetrics, poisoning, HIV and newborn)
• If admitted with acute respiratory failure and another acute condition the selection of PDX will depend on the circumstances of admission and may not be the same in every situation. If both conditions are equally responsible and the focus of care, and there are no chapter-specific sequencing rules, either condition may be sequenced as the PDX (Section II, C.)
• When documentation is unclear a query is necessary
• If there are no clinical indicators present to support acute respiratory failure, pneumonia or other condition in chapter 10, but the diagnosis is documented, a query is necessary to clarify the diagnosis and/or follow facility process on these situations (send to physician liaison or CDI)
• Only confirmed cases of certain identified influenza viruses or other influenza virus should be coded (category J09 and J10)
• When the provider documents “suspected,” “possible” or “probable” avian, novel or other identified influenza the appropriate code from category J11 for unidentified influenza virus should be assigned
• Ventilator associated pneumonia is only reported when clearly documented as such by the provider
• Emphysema is a specified form of COPD
• COPD exacerbation and emphysema diagnosed is assigned to J43.9—emphysema
• Aspiration bronchitis is reported with J69.0—pneumonitis due to inhalation of food and vomit
• Lobar pneumonia is only coded when the diagnosis is specifically documented by the physician as such
• If COPD and unspecified asthma are documented, only the code for COPD would be reported following the instructional note under category J44. If the asthma is documented as a specified type, then both COPD and asthma may be reported
• Pleural effusion associated with heart failure is a common finding and should only be reported when the effusion is specifically addressed or requires therapeutic intervention or diagnostic testing
• If the patient is status post lung transplant and now has pneumonia in the transplanted lung this is considered a complication of the transplanted lung since the pneumonia would affect the function of the organ

Most of the tips above are for pneumonia/COPD but there are many more diagnosis in this chapter of ICD-10-CM. Respiratory diseases are a tough area for coders since there are so many diseases in such a small area of the body. A lot of these diseases intertwine together and it is difficult to know which one to report or if multiple conditions may be reported. Following the instructional notes within ICD-10-CM is a must in this chapter.

Authored by Kim Boy, RHIT, CDIP, CCS, CCS-P

The information contained in this coding advice is valid at the time of posting. Viewers are encouraged to research subsequent official guidance in the areas associated with the topic as they can change rapidly.