Basic ICD-9-CM Coding
2010 edition
Chapter 11:
Diseases of the Respiratory System
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Learning Objectives
• Review the chapter’s learning objectives
• At the conclusion of this chapter, what must you
know about the coding of respiratory diseases
and related procedures
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Diseases of Respiratory System
•
•
•
•
•
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Acute respiratory infections (460–466)
Other diseases of upper respiratory tract
(470–478)
Pneumonia and influenza (480–488)
Chronic obstructive pulmonary disease and allied
conditions (490–496)
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Diseases of Respiratory System
(continued)
• Pneumoconioses and other lung diseases due to
external agents (500–508)
• Other diseases of the respiratory system
(510–519)
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Bronchitis
• Acute bronchitis (466.0)
• Chronic bronchitis (491)
• Not specified as acute or chronic (490)
– Code 490 included in the section with other chronic
lung diseases
• Does physician mean acute when only diagnostic
statement is “bronchitis?” (Probably true if the
patient is a child or young adult)
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Pneumonia
• Pneumonia is classified by causative organism
(480–486) or type of pneumonia (507)
–
–
–
–
–
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Viral
Pneumonococcal
Bacterial
Other organisms
Aspiration
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Pneumonia (continued)
• Physician must document the type of pneumonia
• Laboratory findings (cultures, Gram stains)
cannot substitute for physician documentation
• Patient can have both bacterial and aspiration
pneumonias—code both!
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Asthma
• Category 493
– Also known as reactive airway disease
• Fourth and fifth digits describe the specific type of
asthma
–
–
–
–
–
–
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Extrinsic
Intrinsic
Chronic obstructive
Exercise induced bronchospasm
Cough variant asthma
Unspecified
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Asthma (continued)
• Fifth-digit subclassification must be added to all
codes based on the documentation in the health
record
– 0 Without mention of status asthmaticus
or acute exacerbation or unspecified
– 1 With mention of status asthmaticus
– 2 With mention of acute exacerbation
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Chronic Obstructive Pulmonary
Disease
• Codes 490–496: COPD and allied conditions
• Categories 491–493, 494: specific forms of
COPD
• Category 496: unspecified form of COPD
• See “note” and “excludes note” under category
496
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Respiratory Failure
• Different forms of respiratory failure
– 518.81, Acute respiratory failure or respiratory
failure, not otherwise specified
– 518.83, Chronic respiratory failure
– 518.84, Acute and chronic respiratory failure
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Coding and Sequencing of
Respiratory Failure
• Respiratory failure always caused by an
underlying condition
• It may be due to other respiratory conditions or
due to diseases of other organ systems
• Respiratory failure never exists as a single
condition
• Follow official coding guidelines
• Follow principal diagnosis rules
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Coding and Sequencing of
Respiratory Failure
• There is not one rule for sequencing the
diagnosis of respiratory failure with other
conditions
• When a patient is admitted in respiratory failure
with another acute condition, the principal
diagnosis will not be the same in every situation
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Coding and Sequencing of
Respiratory Failure
• Example 1
• Patient with chronic myasthenia gravis suffers an
acute exacerbation and develops acute
respiratory failure
• Principal diagnosis: 518.81, acute respiratory
failure
• Secondary diagnosis: 358.01, myasthenia gravis
with (acute) exacerbation
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Coding and Sequencing of
Respiratory Failure
• Example 2
• Patient with emphysema develops acute
respiratory failure and is admitted for treatment
of the respiratory failure
• Principal diagnosis: 518.81, acute respiratory
failure
• Secondary diagnosis: 492.8, emphysema
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Coding and Sequencing of
Respiratory Failure
• Example 3
• Patient with congestive heart failure is admitted
to the hospital because of acute respiratory
failure
• Principal diagnosis: 518.81, acute respiratory
failure
• Secondary diagnosis: 428.0, congestive heart
failure
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Coding and Sequencing of
Respiratory Failure
• Example 4
• Patient with asthma in status asthmaticus
develops acute respiratory failure and is admitted
to the hospital for treatment of the respiratory
failure
• Principal diagnosis: 518.81, acute respiratory
failure
• Secondary diagnosis: 493.91, asthma,
unspecified, with status asthmaticus
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Coding and Sequencing of
Respiratory Failure
• Example 5
• Patient is admitted to the hospital during the postpartum
period as a result of developing pulmonary embolism
leading to respiratory failure
• Principal diagnosis: 673.24, obstetrical
blood-clot embolism, postpartum condition or
complication
• Secondary diagnosis: 518.81, acute respiratory failure
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Coding and Sequencing of
Respiratory Failure
• Example 6
• Patient is diagnosed as having overdosed on
crack cocaine and is admitted to the hospital with
respiratory failure
• Principal diagnosis: 970.8, poisoning by other
specified central nervous system stimulant
• Secondary diagnosis: 518.81, acute respiratory
failure
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Coding and Sequencing of
Respiratory Failure
• Example 7
• Patient is admitted with acute respiratory failure
due to Pneumocystis carinii pneumonia which is
due to AIDS
• Principal diagnosis: 042, human
immunodeficiency virus (HIV) disease
• Secondary diagnoses: 518.81, acute respiratory
failure and 136.3, pneumocystosis
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Coding and Sequencing of
Respiratory Failure
• Example 8
• Patient is admitted to the hospital with severe
staphylococcal aureus sepsis and acute
respiratory failure
• Principal diagnosis: 038.11, staphylococcal
aureus septicemia
• Secondary diagnoses: 995.92, systemic
inflammatory response syndrome due to
infectious process with organ dysfunction and
518.81, acute respiratory failure
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Respiratory Procedures
• Closed endoscopic procedures
– Biopsies
– Excision of lesions
• Mechanical ventilation
– Need number of hours patient is on continuous
mechanical ventilation (96.7x)
– Additional code(s) to describe endotracheal
intubation (96.04) or tracheostomy (31.1–31.29)
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Respiratory Procedures
• Non-invasive respiratory assistance
• Delivered by face mask, nasal mask, nasal
pillow, oral mouthpiece or oronasal mask
• Does not require endotracheal tube or
tracheostomy
• Coded with 93.90, Non-invasive mechanical
ventilation
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Respiratory Procedures
• Types of non-invasive respiratory assist
procedures:
–
–
–
–
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Continuous positive airway pressure (CPAP)
Bilevel positive airway pressure (BiPAP)
Noninvasive positive pressure ventilation (NIPPV)
Nonpositive pressure ventilation (NPPV)
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Respiratory Procedures
• If CPAP or BiPAP is delivered via tracheostomy
or through an endotracheal tube, it is considered
invasive mechanical ventilation
– Use subcategory codes 96.7
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