Diagnosing respiratory conditions can be complex. When it comes to reporting diagnoses, physicians can always rely on experienced medical coding companies. With extensive knowledge of the anatomy of the respiratory system, related coding guidelines, and the latest codes and guidelines, skilled medical coding service providers are well-equipped to handle ICD-10 coding for respiratory diseases.
The ICD-10 codes for diseases of the respiratory system are:
- 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 Suppurative and necrotic conditions of the lower respiratory tract
- J90-J94 Other diseases of the pleura
- J95-J95 Intraoperative and postprocedural complications and disorders of respiratory system, not elsewhere classified
- J96-J99 Other diseases of the respiratory system
ICD-10 codes for Common Respiratory Conditions
This article discusses the ICD-10 coding guidelines for six common respiratory conditions – sinusitis, pharyngitis, influenza, pneumonia, chronic obstructive pulmonary disease (COPD), and bronchitis.
WebMD defines sinusitis as “an inflammation, or swelling, of the tissue lining the sinuses”. According to the Centers for Disease Control and Prevention (CDC), in 2015, about 29.4 million adults (12.1 percent) in the US were diagnosed with sinusitis.
The ICD-10 code set for sinusitis is J00-J99 which includes acute, acute recurrent and chronic sinusitis codes for maxillary, frontal, ethmoidal, and sphenoidal and pansinusitis. Here are some examples from each of these categories:
- J01.00 Acute maxillary sinusitis
- J01.11 Acute recurrent frontal sinusitis
- J32.2 Chronic ethmoidal sinusitis
- J01.30 Acute sphenoidal sinusitis
- J01.41 Acute recurrent pansinusitis sinusitis
- J32.8 Other chronic sinusitis
- J01.91 Acute recurrent sinusitis, unspecified
When applicable, an additional code should be used to identify:
- Exposure to environmental tobacco smoke
- Exposure to tobacco smoke in the perinatal period
- History of tobacco use
- Occupational exposure to environmental tobacco smoke
- Tobacco dependence
- Tobacco use
If the patient also has documented chronic sinusitis, it should be coded in addition to the code for the acute condition
Pharyngitis or sore throat is inflammation of the pharynx. Pharyngitis-induced sore throat is one of the most common reasons why people see their physician, according to the American Osteopathic Association (AOA). Pharyngitis may be caused by bacterial or viral infections. The condition is more widespread in the colder months and one of the most common reasons for missing work. The condition can be acute or chronic and due to streptococcus, due to a known agent other than streptococcus, or unspecified. The ICD-10 codes for pharyngitis are:
- J02.0 Streptococcal pharyngitis
- J02.8 Acute pharyngitis due to other specified organisms
- J02.9 Acute pharyngitis, unspecified
- J31.1 Chronic nasopharyngitis
- J31.2 Chronic pharyngitis
There are three types of influenza virus: A, B, and C. Types A and B are responsible for seasonal epidemics, while type C causes mild respiratory illness and not epidemics, according to the Centers for Disease Control and Prevention.
- Documenting the type and manifestations of the virus is necessary to assign the correct ICD-10 code for influenza.
- There are additional codes for influenza virus infections such as avian, swine, etc.
- Under ICD-10, J11.1 is used to report Influenza due to unidentified influenza virus with other respiratory manifestations, and additional codes should be used for associated pleural effusion and sinusitis, if applicable.
Influenza due to unidentified influenza virus
- J11.00 With unspecified type of pneumonia
- J11.1 With other respiratory manifestations
- J11.2 With gastrointestinal manifestations
- J11.3 With otitis media
- J11.89 With other manifestations
Mayo Clinic describes pneumonia as “an infection that inflames the air sacs in one or both lungs”. According to the American Thoracic Society, pneumonia is the most common reason for hospital admission of children in the U.S., other than women giving birth. About 1 million adults in the country are hospitalized with pneumonia every year, and about 50,000 die from this disease.
- Community-acquired pneumonia is diagnosed based on the history and physical examination. In most cases, only one ICD-10 code will apply:
- J18.9, Pneumonia, unspecified organism
- If there are additional clinical findings, more specific codes can be used:
- J18.0 Bronchopneumonia, unspecified organism
- J18.1 Lobar pneumonia, unspecified organism
- J18.2 Hypostatic pneumonia, unspecified organism
- J18.8 Other pneumonia, unspecified organism
- There are several ICD-10 codes that should be used if the documentation indicates a positive sputum culture. For e.g.,:
- J12.0 – J12.9 Viral pneumonia
- J13 – J17 Bacterial pneumonia
The base ICD-10 code categories for these conditions are:
- J43 for emphysema
- J44 for chronic obstructive pulmonary disease (COPD)
Additional testing is usually necessary to differentiate emphysema from chronic bronchitis. Per the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health, “Most people who have COPD have both emphysema and chronic bronchitis. Therefore, the general term ‘COPD’ is considered more accurate and J44.9, COPD, unspecified should be used.”
- Codes would also depend on whether the condition is acute, chronic, or in acute exacerbation. ICD-10 guidelines state that, “If the same condition is described as both acute (subacute) and chronic, and separate subentries exist in the Alphabetic Index at the same indention level, code both and sequence the acute (subacute) code first.”
- When chronic COPD is confirmed, report:
- J44 Other chronic obstructive pulmonary disease
- J44.0 Chronic obstructive pulmonary disease with acute lower respiratory infection
- J44.1 Chronic obstructive pulmonary disease with (acute) exacerbation
- J44.9 Chronic obstructive pulmonary disease, unspecified
- If the documentation does not indicate a definitive diagnosis of COPD, only the symptoms should be coded.
This is a common conditions treated by primary care physicians. Bronchitis refers to inflammation of the bronchi, the passages that extend from the trachea into the small airways and alveoli of the lungs. Common symptoms of bronchitis include cough, sore throat, runny or stuffy nose, headache, muscle aches, and fatigue. While acute bronchitis is caused by viruses and bacterial infections, chronic bronchitis is mainly caused by cigarette smoking and air pollution.
- The documentation requirements for bronchitis include type, temporal factors, associated condition, and cause or contributing factors.
- In ICD-10, bronchitis codes are categorized as acute and chronic
- Acute bronchitis codes are further categorized by causal organism. For e.g.:
- J20.0 Acute bronchitis due to Mycoplasma pneumoniae
- J20.4 Acute bronchitis due to parainfluenza virus
- J20.7 Acute bronchitis due to echovirus
- Chronic bronchitis codes are categorized as simple, mucopurulent, or mixed. For example:
- J41.0 Simple chronic bronchitis
- J41.1 Mucopurulent chronic bronchitis
- J41.8 Mixed simple and mucopurulent chronic bronchitis
- Each subcategory has an unspecified code. If documentation does not specify a time parameter, J40 Bronchitis, not specified as acute or chronic can be assigned through this should be avoided, if possible.
Correct coding of respiratory conditions under ICD-10 requires vigilance about matters such as symptoms versus diagnosis, acute versus acute recurrent, and unspecified vs. lacking specific documentation. The support of an experienced and dedicated AAPC-certified medical coding service provider can ensure compliance, reduce risk of denials and optimize reimbursement.