Documenting Bronchiolitis – A Common Pediatric Respiratory Infection

by | Published on Jan 5, 2021 | Medical Coding

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Regarded as a common lower respiratory tract infection in young children and infants, bronchiolitis causes inflammation and congestion in the small airways (bronchioles) of the lung. Affecting children and babies (below the age of 2 years), the condition is generally caused by a virus that affects the smallest air passages in the lungs (called the bronchioles). Bronchioles help control airflow in the lungs. Any specific damage or infection within the bronchioles can make them swell or become clogged thereby blocking the free of oxygen. Typically, the peak time for bronchiolitis is during the winter months. Most cases of bronchiolitis are mild and clear up within 2-3 weeks even without any specific treatment. On the other hand, some children experience severe symptoms and need hospital treatment. The treatment modalities for this condition depend on when the condition was diagnosed and how far the condition has progressed. Physicians while diagnosing the symptoms should correctly document the procedures performed in the patients’ medical records. Correct diagnosis of bronchiolitis symptoms is crucial to provide appropriate care and treatment. Outsourcing billing and coding tasks to a reliable medical billing and coding company can help physicians simplify their documentation process.

Most cases of bronchiolitis are caused by the respiratory syncytial virus (RSV). RSV is a common virus that affects children by the age of 2 years and is also common in babies less than 1 year of age. The contagious virus produces inflammation, mucus, and swelling in the airways. Other viruses like adenoviruses (that target mucous membranes), influenza viruses (that cause inflammation in the lungs, nose, and throat) also cause this specific condition. In fact, these viruses can easily spread and contract through droplets in the air when someone who is sick coughs, sneezes or talks. It can also be spread by touching shared objects (such as toys or towels) and then touching the eyes, nose or mouth. In addition, in some rare cases, bronchiolitis can also occur due to other causes like respiratory infections, adverse reactions to medications and exposure to fumes from chemicals (like ammonia, bleach, and chlorine).

Identifying the Symptoms and Risk Factors

The signs and symptoms associated with the condition are similar to those of a common cold such as a runny/stuffy nose and a cough. These symptoms can last for several days to weeks. However, as the condition progresses, patients experience other related symptoms like –

  • Rapid or shallow breathing
  • Wheezing
  • Turning blue or gray in the lips, fingertips or toes
  • Ribs that appear sunken during attempts to inhale (in children)
  • Nasal flaring (in babies)
  • Making grunting noises
  • Having trouble sucking and swallowing
  • Fatigue
  • Crackling or rattling sounds heard in the lungs
  • Being sluggish

As mentioned above, bronchiolitis typically affects children under the age of 2 years. On the other hand, infants (younger than 3 months of age) are at greatest risk of getting bronchiolitis as their lungs and immune systems do not get fully developed. Other factors that are linked with an increased risk of bronchiolitis in infants include – premature birth, underlying heart or lung condition, never having been breast-fed (breast-fed babies receive immune benefits from the mother), exposure to tobacco smoke and weakened immune system.

Bronchiolitis and Bronchitis – Primary Point of Difference

These conditions not only sound similar, but are similar in some ways. Both the conditions are caused by a virus and both affect the smaller airways – bronchioles. Bronchitis generally affects older children and adults, while bronchiolitis is more common in younger children.

Diagnosing and Treating Bronchiolitis

Diagnosis of this condition is usually based on the symptoms and an examination of the child’s breathing. Physicians will examine the child and listen to their lungs. A pulse oximeter – an electronic device – can be placed painlessly on the fingertips or toes of the child to find out how much oxygen is there in the child’s blood. Physicians may also ask about the signs of dehydration, especially if the child has been refusing to drink or eat or has been vomiting. In case of severe bronchiolitis, if the symptoms are worsening or if another problem is suspected, physician may order other tests, like- Chest X-ray, Blood tests (to check the white blood cell count) and Viral testing (collecting a sample of mucus to test for the virus) causing bronchiolitis.

As mentioned above, bronchiolitis typically lasts for two to three weeks. In most cases, children with bronchiolitis can be cared for at home with supportive care. However, it is important to be alert for changes in breathing such as difficulty to breathe or making grunting noises with each breath. As viruses cause bronchiolitis, antibiotics used to treat infections caused by bacteria – will not be effective. In some cases, bacterial infections (such as pneumonia or an ear infection) can occur along with bronchiolitis and the doctor may prescribe an antibiotic for that infection. A small percentage of children may need immunosuppressant medications, oxygen therapy or intravenous (IV) fluids, which will be prescribed by the physicians and given in the hospital. Breathing exercises and stress reduction can help ease breathing difficulties. The diagnostic tests and treatment procedures for bronchiolitis must be correctly documented using the right codes. Outsourced billing services from a reliable and experienced medical billing company can help physicians report the correct billing codes. ICD-10 codes include –

  • J21 Acute bronchiolitis
  • J21.0 Acute bronchiolitis due to respiratory syncytial virus
  • J21.1 Acute bronchiolitis due to human metapneumovirus
  • J21.8 Acute bronchiolitis due to other specified organisms
  • J21.9 Acute bronchiolitis, unspecified
  • J22 Unspecified acute lower respiratory infection

Bronchiolitis can be spread through close contact, saliva and mucus. Recovery from this condition requires extra rest and increased fluid intake. The virus that causes bronchiolitis is very common and easily spread, therefore preventing it completely is not possible. However, it is possible to reduce the likelihood of your child developing or spreading the infection by following certain steps like – maintaining a smoke-free environment, humidifying the air, frequently offering small amounts of fluid (such as water or juice to prevent dehydration), trying saline nose drops (to ease congestion), OTC pain relievers, avoiding contact with others who are sick and practicing good hand washing habits.

Medical billing and coding for bronchiolitis can be complex. By outsourcing physician billing services, healthcare practices can ensure correct and timely medical billing and claims submission.

Rajeev Rajagopal

Rajeev Rajagopal, the President of OSI, has a wealth of experience as a healthcare business consultant in the United States. He has a keen understanding of current medical billing and coding standards.

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