CHAPTER 10 – DISEASES OF THE RESPIRATORY SYSTEM – Part 1
Over the next several months a lot of information will be posted concerning the do’s and don’ts of ICD-10-CM. At times it may be overwhelming. You will find the transition to be easier and less stressful the earlier you start training.
This week the focus will be on the Respiratory System. Many familiar conditions are identified in this chapter such as Asthma, COPD and Pneumonia.
The Respiratory System is made up of organs and tissues that enable us to breathe.
- Nose and Nasal Cavities
- Bronchial Tubes or Bronchi, and their tubes
- Right Lung – 3 lobes
- Left Lung – 2 lobes
Lower Linked Vessels – Provide pulmonary circulation
- Muscles in the Neck and Collarbone area – (accessory muscles)
Here is a list of common signs and symptoms seen in the Respiratory System that may be indicative of a more severe condition. Keep in mind, you always want to be as specific as possible when coding for appropriate reimbursement and data quality.
- Shortness of breath
- Intercostal pain
- Respiratory arrest
Categories J00 – J99
- J00 – J06 Acute Upper Respiratory Infections
- J09 – J18 Influenza and Pneumonia
- J20 – J22 Other Acute Lower Respiratory Infections
- J30 – J39 Other Diseases of Upper Respiratory Tract
- J40 – J47 Chronic Lower Respiratory Diseases
- J60 – J70 Lung Diseases due to External Agents
- J80 – J84 Other Respiratory Diseases Principally Affecting the Interstitium
- J85 – J86 Supportive and Necrotic Conditions of the Lower Respiratory Tract
- J90 – J94 Other Diseases of the Pleura
- J95 Intraoperative and Postprocedural Complications and Disorders of Respiratory System, Not Elsewhere Classified
- J96 – J99 Other Diseases of the Respiratory System
Classification changes in ICD-10 will provide greater specificity.
While the overall organization of ICD-10 is similar to ICD-9, diseases have been rearranged. Certain diseases/disorders have been removed from other chapters and placed in Chapter 10.
- Streptococcal Pharyngitis (J02.0) now classified in Chapter 10, no longer will be classified with the Infectious and Parasitic Disease Chapter.
- Ventilator Associated Pneumonia (J95.851) was previously found in the “Injury and Poisoning” Chapter in ICD-9-CM.
- Intraoperative and post-procedure complications pertaining to the Respiratory System have been grouped together in Chapter 10 – J95.
Some codes in Chapter 10 have been expanded to include notes indicating that an additional code should be assigned or an associated condition should be sequenced first. Example:
- Use additional code to identify the infectious agent
- Use additional code to identify the virus
- Code first any associated lung abscess
- Code first the underlying disease
- Use additional code to identify other conditions such as tobacco use or exposure
As with any chapter in ICD-10, coders must be familiar with the Official Coding Rules and Guidelines. Refer to http://www.cdc.gov/nchs/data/icd/icd10cm_guidelines_2014.pdf.
COPD and ASTHMA
Many of the instructions in ICD-9-CM pertaining to COPD have been eliminated in ICD-10-CM. Here are the two hair splitting requirements in ICD-9 that have been eliminated in ICD-10:
- Physicians will no longer have to distinguish Asthma as Intrinsic or Extrinsic.
- Will no longer need separate codes for “Chronic Obstructive Asthma”, as opposed to “Chronic Obstructive Bronchitis” or plain ole “COPD”.
- In ICD-10-CM, Asthma is just Asthma and COPD is just COPD.
If a patient is documented with both COPD and Asthma, two codes will be required to show each condition.
Terminology terms have been updated and added to reflect current the clinical classification of Asthma – J45. Asthma must be documented as mild, moderate or severe. Mild Asthma must be documented as intermittent or persistent.
- Mild intermittent Asthma
- Uncomplicated – J45.20
- With (Acute) Exacerbation – J45.21
- With Status Asthmaticus – J45.22
- Mild persistent Asthma
- Uncomplicated – J45.30
- With (Acute) Exacerbation – J45.31
- With Status Asthmaticus – J45.32
- Moderate persistent Asthma
- Uncomplicated – J45.40
- With (Acute) Exacerbation – J45.41
- With Status Asthmaticus – J45.42
- Severe persistent Asthma
- Uncomplicated – J45.50
- With (Acute) Exacerbation – J45.51
- With Status Asthmaticus – J45.52
Intrinsic (non-allergic) and Extrinsic (allergic) Asthma will both be classified to J45.909 – Unspecified Asthma, Uncomplicated.
MMP highly recommends an early start with ICD-10-CM/PCS training. There is no doubt the transition will be challenging. Any type of procrastination is sure to bring on stress with increased complexity and costs. Early planning and preparation will be the key to a smooth and successful transition. For timely updates and informative articles, Continue to follow MMP through their weekly newsletter Wednesday@One Part 2 of Chapter 10 – Diseases of the Respiratory System will post March 12, 2014.
Illustration: Gray, Henry. Anatomy of the Human Body. Philadelphia: Lea & Febiger, 1918; Bartleby.com, 2000. www.bartleby.com/107/. [Date of Printout].
Article by Marsha Manning