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Chapter 10: Diseases of the Respiratory System
Comprehensive coding guidelines for Respiratory System diseases (J00-J99), U07.0
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Section A
Chronic Obstructive Pulmonary Disease [COPD] and Asthma
1. Acute exacerbation of chronic obstructive bronchitis and asthma
The codes in categories J44 and J45 distinguish between uncomplicated cases and those in acute exacerbation. An acute exacerbation is a worsening or a decompensation of a chronic condition. An acute exacerbation is not equivalent to an infection superimposed on a chronic condition, though an exacerbation may be triggered by an infection.
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Section B
Acute Respiratory Failure
Acute respiratory failure as principal diagnosis
A code from subcategory J96.0, Acute respiratory failure, or subcategory J96.2, Acute and chronic respiratory failure, may be assigned as a principal diagnosis when it is the condition established after study to be chiefly responsible for occasioning the admission to the hospital, and the selection is supported by the Alphabetic Index and Tabular List. However, chapter-specific coding guidelines (such as obstetrics, poisoning, HIV, newborn) that provide sequencing direction take precedence.
Acute respiratory failure as secondary diagnosis
Respiratory failure may be listed as a secondary diagnosis if it occurs after admission, or if it is present on admission, but does not meet the definition of principal diagnosis.
Sequencing of acute respiratory failure and another acute condition
When a patient is admitted with respiratory failure and another acute condition, (e.g., myocardial infarction, cerebrovascular accident, aspiration pneumonia), the principal diagnosis will not be the same in every situation. This applies whether the other acute condition is a respiratory or nonrespiratory condition. Selection of the principal diagnosis will be dependent on the circumstances of admission. If both the respiratory failure and the other acute condition are equally responsible for occasioning the admission to the hospital, and there are no chapter-specific sequencing rules, the guideline regarding two or more diagnoses that equally meet the definition for principal diagnosis (Section II, C.) may be applied in these situations. If the documentation is not clear as to whether acute respiratory failure and another condition are equally responsible for occasioning the admission, query the provider for clarification.
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Section C
Influenza due to Certain Identified Influenza Viruses
Code only confirmed cases of influenza due to certain identified influenza viruses (category J09), and due to other identified influenza virus (category J10). This is an exception to the hospital inpatient guideline Section II, H. (Uncertain Diagnosis).
In this context, "confirmation" does not require documentation of positive laboratory testing specific for avian or other novel influenza A or other identified influenza virus. However, coding should be based on the provider's diagnostic statement that the patient has avian influenza, or other novel influenza A, for category J09, or has another particular identified strain of influenza, such as H1N1 or H3N2, but not identified as novel or variant, for category J10.
Suspected or Probable Cases
If the provider records "suspected" or "possible" or "probable" avian influenza, or novel influenza, or other identified influenza, then the appropriate influenza code from category J11, Influenza due to unidentified influenza virus, should be assigned. A code from category J09, Influenza due to certain identified influenza viruses, should not be assigned nor should a code from category J10, Influenza due to other identified influenza virus.
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Section D
Ventilator Associated Pneumonia
1. Documentation of Ventilator associated Pneumonia
As with all procedural or postprocedural complications, code assignment is based on the provider's documentation of the relationship between the condition and the procedure. Code J95.851, Ventilator associated pneumonia, should be assigned only when the provider has documented ventilator associated pneumonia (VAP). An additional code to identify the organism (e.g., Pseudomonas aeruginosa, code B96.5) should also be assigned. Do not assign an additional code from categories J12-J18 to identify the type of pneumonia.
2. Ventilator associated Pneumonia Develops after Admission
A patient may be admitted with one type of pneumonia (e.g., code J13, Pneumonia due to Streptococcus pneumonia) and subsequently develop VAP. In this instance, the principal diagnosis would be the appropriate code from categories J12-J18 for the pneumonia diagnosed at the time of admission. Code J95.851, Ventilator associated pneumonia, would be assigned as an additional diagnosis when the provider has also documented the presence of ventilator associated pneumonia.
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Section E
Vaping-Related Disorders
For patients presenting with condition(s) related to vaping, assign code U07.0, Vaping-related disorder, as the principal diagnosis. For lung injury due to vaping, assign only code U07.0. Assign additional codes for other manifestations, such as acute respiratory failure (subcategory J96.0-) or pneumonitis (code J68.0).
Respiratory Symptoms
Associated respiratory signs and symptoms due to vaping, such as cough, shortness of breath, etc., are not coded separately, when a definitive diagnosis has been established.
Gastrointestinal Symptoms
However, it would be appropriate to code separately any gastrointestinal symptoms, such as diarrhea and abdominal pain.
See Section I.C.1.g.1.c.i. for Pneumonia confirmed as due to COVID-19
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Scenario Examples
5 Scenario Examples for ICD-10-CM Chapter 10 Guidelines
1
COPD with Acute Exacerbation
A 68-year-old patient with a history of chronic obstructive pulmonary disease presents to the emergency department with increased shortness of breath, productive cough, and wheezing for the past 3 days. The physician documents "COPD with acute exacerbation." Code: J44.1 (Chronic obstructive pulmonary disease with acute exacerbation). This scenario demonstrates the distinction between uncomplicated COPD and acute exacerbation, where the worsening of the chronic condition is clearly documented.
2
Acute Respiratory Failure as Principal Diagnosis
A 55-year-old patient is admitted to the hospital with severe respiratory distress. After examination and testing, the physician determines the patient has acute respiratory failure due to pneumonia. The respiratory failure is the condition chiefly responsible for the admission. Code: J96.00 (Acute respiratory failure, unspecified whether with hypoxia or hypercapnia) as principal diagnosis, followed by the appropriate pneumonia code. This illustrates when respiratory failure can be sequenced as the principal diagnosis.
3
Confirmed H1N1 Influenza
A 42-year-old patient presents with fever, body aches, and respiratory symptoms. The provider documents "H1N1 influenza" based on clinical presentation and rapid flu test. Code: J10.1 (Influenza due to other identified influenza virus with other respiratory manifestations). This scenario shows proper coding of confirmed identified influenza strains, even without specific laboratory confirmation, based on provider documentation.
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Scenario Examples Continued
Additional Clinical Scenarios
1
Ventilator Associated Pneumonia
A 70-year-old patient is admitted for acute respiratory failure and placed on mechanical ventilation. On day 5 of hospitalization, the patient develops fever and new infiltrates on chest X-ray. The provider documents "ventilator-associated pneumonia due to Pseudomonas aeruginosa." Codes: Principal diagnosis would be the original condition that required ventilation, J95.851 (Ventilator associated pneumonia) as additional diagnosis, and B96.5 (Pseudomonas aeruginosa as the cause of diseases classified elsewhere). This demonstrates proper coding when VAP develops after admission.
2
Vaping-Related Lung Injury
A 25-year-old patient presents to the emergency department with severe shortness of breath, chest pain, and cough. The patient reports regular use of e-cigarettes. After evaluation, the physician documents "lung injury due to vaping with acute respiratory failure." Codes: U07.0 (Vaping-related disorder) as principal diagnosis, J96.00 (Acute respiratory failure) as additional diagnosis. The respiratory symptoms (cough, shortness of breath) are not coded separately as they are integral to the vaping-related disorder diagnosis. This scenario illustrates the proper sequencing and coding of vaping-related conditions.
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Key Takeaways
Essential Coding Guidelines Summary
COPD and Asthma
Always distinguish between uncomplicated cases and acute exacerbations. Remember that acute exacerbation represents worsening of chronic condition, not necessarily infection.
Respiratory Failure
Sequencing depends on circumstances of admission. When respiratory failure and another condition are equally responsible, apply Section II, C. guidelines or query the provider.
Influenza Coding
Code only confirmed cases for categories J09 and J10. Use category J11 for suspected, possible, or probable cases. Provider documentation is key.
VAP Documentation
Assign J95.851 only when provider specifically documents ventilator-associated pneumonia. Always add organism code. Query if documentation is unclear.
Vaping Disorders
U07.0 is principal diagnosis for vaping-related conditions. Code additional manifestations separately. Respiratory symptoms are not coded separately when definitive diagnosis established.
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