August 2011 | Back to Full Issue


The Respiratory System

By Cortnie R. Simmons, MHA, RHIA, CCS

The respiratory system comprises all the organs and structures involved in breathing. It works as a purifying system, filtering air and carrying oxygen to the blood cells and carrying carbon dioxide out of the body. This article highlights some of the changes and new features in the respiratory chapter of ICD-10 CM and associated ICD-10-PCS procedure codes.

ICD-10-CM and the Respiratory System

ICD-10-CM’s chapter 10: Disease of the Respiratory System contains the respiratory diagnosis codes. In ICD-9-CM, these diseases and corresponding codes were found in Chapter 6. The ICD-10-CM codes, JJ00-J99, are as follows:

  • 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 Disease due to External Agents
  • J80-J84: Other Respiratory Disease Principally affecting the Interstitium
  • J85- J86: Suppurative and Necrotic Conditions of the Lower Respiratory Tract
  • J90-J94: Other Disease of the Pleura
  • J95: Intraoperative and Postprocedural Complications and Disorders of Respiratory System, Not Elsewhere Classified
  • J96-J99: Other Disease of the Respiratory System

ICD-10-CM Guideline Changes

The ICD-10-CM Official Guidelines for Coding and Reporting specifically addresses coding acute exacerbation of chronic obstructive bronchitis and asthma, acute reparatory failure, and influenza due to avian influenza virus. The guidelines found in this chapter are very similar to current ICD-9-CM guidelines. There are minor changes with the elimination of instructions related to chronic obstructive pulmonary disease (COPD).
Additional instructions have been added for the diagnosis of ventilator associated pneumonia (VAP), with complication code assignment based on provider documentation. Pneumonia documented as associated with the use of a ventilator is assigned code J95.851; ventilator associated pneumonia. Any associated organisms are coded as a secondary diagnosis. For example, VAP due to staphylococcus aureus is coded as J95.851 and B95.6. Because a patient is admitted with one type of pneumonia and subsequently develops VAP later, two codes are assigned if documented appropriately. The coder would assign a code for the type of pneumonia diagnosed at the time of admission and code J95.851 as an additional diagnosis for the VAP.

New ICD-10-CM Documentation

Additional elements are required to be documented for ICD-10-CM coding. Asthma is classified to category J45, with a fourth character indicating the severity. Severity is identified as mild intermittent, mild persistent, moderate persistent, severe persistent, other or unspecified. Additionally, characters identify whether status asthmaticus or exacerbation is present. For example, mild intermittent asthma with status asthmaticus is coded to J45.22.

ICD-10-PCS and the Respiratory System

When assigning ICD-10-PCS codes for procedures performed on the respiratory system, it is important to ensure that adequate documentation is provided for correct ICD-10 PCS code assignment. Let’s take a look at the structure of an ICD-10-PCS code.


Character 1-Section

Character 2-     Body System

Character 3-  Root Operation

Character  4-Body Part

Character 5-Approach

Character  6-Device

Character 7-Qualifier

An important element in proper code assignment in this system is determining where the procedure was performed. For instance, which lobe of the lung? Was it right, left, or bilateral? ICD-10-PCS contains various root operations to code procedures in the respiratory system; some examples of the root operations commonly used are destruction, drainage, excision, insertion, and extirpation.

Surgical approaches are also important in correct code determination. For example, a thoracoscopic procedure typically is performed via a percutaneous endoscopic approach, while bronchoscopic procedures are performed via a natural or artificial opening endoscopic.

The device and qualifier character are used to identify additional information when assigning ICD-10-PCS codes. For example, codes representing excisional biopsies performed on the bronchus contain the qualifier character of diagnostic.

Mechanical Ventilation

A major procedural change associated with respiratory diseases in ICD-10-PCS is coding  mechanical ventilations. Mechanical ventilations are considered  noninvasive when delivered via a noninvasive interface like a face mask or mouthpiece and invasive when delivered via an invasive interface such as endotracheal intubation or tracheostomy received in an interrupted fashion. The definition of the root operation “assistance” is taking over a portion of a physiological function by extracorporeal means. The root operation “performance” is defined as procedures completely take over the physiological function by extracorporeal means. To accurately assign a PCS code for ventilation procedures, one must know how much of the breathing function is being performed by the patient versus a machine.

Coders  need to identify the duration of the ventilation via character five. ICD-10-PCS identifies the duration as:

  • Less than 24 consecutive hours
  • 24-96 consecutive hours
  • Greater than 96 consecutive hours

Let’s look at an example. 5A1955Z is used for coding respiratory mechanical ventilation, greater than 96 consecutive hours. The explanation of this code is found below:


Character 1-Section

Character 2-     Body System

Character 3-  Root Operation

Character  4-Body System

Character 5-Duration

Character  6-Function

Character 7-Qualifier

5

A

1

9

5

5

Z

Extracorporeal Assistance and Performance

Physiological Systems

Performance

Respiratory

Greater than 96 hours

Ventilation

No Qualifier

 The seventh character, qualifier, specifies various ways to assist ventilation, typically seen with noninvasive methods. For the root operation assistance the values are:

  • 7: Continuous positive airway pressure
  • 8: Intermittent positive airway pressure
  • 9: Continuous negative airway pressure
  • B: Intermittent negative airway pressure
  • Z: No Qualifier

An example  is code 5A09457- Assistance with respiratory ventilation, 24-96 consecutive hours, continuous positive airway pressure. An explanation of this code is seen below:


Character 1-Section

Character 2-     Body System

Character 3-  Root Operation

Character  4-Body System

Character 5-Duration

Character  6-Function

Character 7-Qualifier

5

A

0

9

4

5

7

Extracorporeal Assistance and Performance

Physiological Systems

Assistance

Respiratory

24-96 Consecutive hours

Ventilation

Continuous Positive Airway Pressure

As reviewed the respiratory system has modifications in ICD-10-CM and ICD-10-PCS. It is important to review on this body system in addition to all others. The more we plan for ICD-10-CM/PCS the better prepared we will be, and we will be able to “breathe” a little easier!

 

Cortnie Simmons is the National Compliance Manager at Kforce Healthcare and currently oversees ICD-10 implementation internally and externally.


References:

Contexo Media. Advanced Anatomy and Physiology for ICD-10. Contexo Media, 2010.

Ingenix. Comprehensive Anatomy and Physiology for ICD-10-CM Coding. Ingenix, 2011.

 

 

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