ICD-9 Respiratory System Changes for Oct. 1

There are a number of new and revised ICD-9-CM codes effective Oct. 1, 2011. Included here is an overview of some of the new respiratory system diagnosis codes and their clinical meanings. As previously stated in this column, coders must understand the clinical meaning of new codes and be able to differentiate them from other similar existing codes.

Novel Influenza
This is the third year in a row that changes have been made to these codes. Influenza causes significant morbidity and mortality worldwide. New forms can threaten to spread widely, with little existing immunity in populations. Changes to the novel influenza codes were recommended by the CDC National Center for Immunization and Respiratory Diseases (NCIR).

A new subcategory 488.8, Influenza due to novel influenza A, and associated codes have been created to report Novel influenza A.

  • 488.81 Influenza due to identified novel influenza A virus with pneumonia
  • 488.82 Influenza due to identified novel influenza A virus with other respiratory manifestations
  • 488.89 Influenza due to identified novel influenza A virus with other manifestations

Novel influenza A is a nationally reportable disease. It includes all human infections with influenza A viruses that are new or different from currently circulating human influenza viruses. These include viruses subtyped as nonhuman in origin, and those that cannot be subtyped with standard laboratory methods.

The 2009 pandemic influenza is now regularly referred to as 2009 H1N1 influenza, rather than novel H1N1 influenza. As a result the following codes have been revised and references to “novel” in these codes have been changed to “2009”:

  • 488.11 Influenza due to identified 2009 H1N1 influenza virus with pneumonia
  • 488.12 Influenza due to identified 2009 H1N1 influenza virus with other respiratory manifestations
  • 488.19 Influenza due to identified 2009 H1N1 influenza virus with other manifestations

Pneumothorax and Air Leak
New codes have been created and revisions have been made to Category 512 to differentiate air leaks from pneumothorax. This category is now labeled pneumothorax and air leaks.

New code 512.2 has been created to report postoperative air leaks. This condition was previously reported with code 512.1, iatrogenic pneumothorax, which was misleading because a patient can have a postoperative air leak without significant air in the pleural space causing pneumothorax. It is not appropriate to report codes 512.1 or 512.2 unless the physician documentation specifically indicates postoperative or due to a procedure.

Patients may also have a persistent air leak that is not postoperative, such as when a chest tube has been placed for a spontaneous pneumothorax and the lung re-expands but the air leak persists.

Spontaneous pneumothorax may be primary, or secondary and related to various other conditions such as cystic fibrosis, spontaneous rupture of the esophagus, lung cancer, etc.

Code 512.8 was expanded and now includes 4 new codes to report other spontaneous pneumothorax and air leak.

  • 512.81 Primary spontaneous pneumothorax
  • 512.82 Secondary spontaneous pneumothorax
  • 512.83 Other air leak
  • 512.89 Other pneumothorax

When reporting code 512.82, secondary spontaneous pneumothorax, the cause should be coded first. Code 512.89 is used to report chronic pneumothorax, pneumothorax and spontaneous pneumothorax not otherwise specified.

Postoperative Respiratory Failure
Code 518.5, Pulmonary insufficiency following trauma and surgery, has been expanded and includes three new codes.

  • 518.51 Acute respiratory failure following trauma and surgery
  • 518.52 Other pulmonary insufficiency, not elsewhere classified, following trauma and surgery
  • 518.53 Acute and chronic respiratory failure following trauma and surgery

These new codes were created to distinguish postoperative acute respiratory failure from less severe respiratory complications of surgery or trauma. Code 518.52 is used to report adult respiratory distress syndrome, pulmonary insufficiency following surgery or trauma and shock lung related to trauma and surgery. The less severe respiratory complications may only require supplemental oxygen or observation in comparison to acute respiratory failure, which may require intubation and extended length of stay.

Test your knowledge with the following quiz (assume new codes are valid):

Questions:

1. A 10-year-old male presents to the hospital with flu-like symptoms of cough, fever and chills that has worsened over the last few days to include severe chest congestion. He was admitted to the hospital to rule out H1N1 influenza with pneumonia and was treated with Tamiflu. The patient’s symptoms resolved and she was discharged home. The physician documented “probable H1N1 flu” in the discharge summary. Which of the following would be the appropriate diagnosis code(s)?

a. 488.11, 486

b. 488.12

c. 487.0, 486

d. 487.1


2. A patient was admitted with burns to the arms and respiratory failure due to smoke inhalation when a fire started in his home. Which of the following would be the appropriate diagnosis codes?

a. 506.3, 518.51, 943.00, E890.2

b. 506.3, 518.81, 943.00, E890.2

c. 518.51, 943.00, E890.2

d. 987.9, 518.81, 943.00, E890.2

This month’s column has been prepared by Cheryl D’Amato, RHIT, CCS, director of HIM, hospital solutions, and Melinda Stegman, MBA, CCS, clinical technical editor, Ingenix.

Coding Clinic is published quarterly by the American Hospital Association.
CPT is a registered trademark of the American Medical Association.

Answers:

1. d: Assign code 487.1, Influenza with other respiratory manifestations. Code 488.12, Influenza due to identified 2009 H1N1 influenza virus with other respiratory manifestations, should not be assigned in this instance because the physician did not confirm that the patient had H1N1 influenza. Category 488 codes should not be reported when the physician indicates that the infection is suspected, probable, questionable, etc. This is an exception to the hospital inpatient coding guideline to assign a code documented as suspected or possible as if it were established. Code 487.0, Influenza with pneumonia should also not be assigned because the physician did not document that the patient had pneumonia. The physician should be queried if additional info is needed.

2. a: Assign code 506.3, Other acute and subacute respiratory conditions due to fumes and vapors, as principal diagnosis, to report respiratory problems due to smoke inhalation. Assign codes 518.51, Acute respiratory failure following trauma and surgery, 943.00, Burn of upper limb, except wrist and hand, unspecified degree, and E890.2, Conflagration in private dwelling, other smoke and fumes from conflagration, as additional codes. Code 987.9, Toxic effect, unspecified gas, fume, or vapor, would not be assigned as the principal diagnosis in this instance because codes in category 980-989, Toxic effects of substances chiefly nonmedicinal as to source, exclude respiratory conditions due to external agents.

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