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Lower Respiratory Disorders Flashcards

(49 cards)

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1
Q

Lower Respiratory tract consists of?

A
  1. Trachea
  2. Bronchi
  3. Bronchioles
  4. Alveoli
  5. Lungs
  6. Pleura
  7. Pleural Cavity
  8. Mediastinum
  9. Diaphragm
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2
Q

What chapter and rubric block are respiratory diseases generally coded to?

A

Chapter X
(J00-J99)

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3
Q

Respiratory diseases occurring in more than one site in the respiratory system are coded to where?

A

The lowest anatomical site

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4
Q

Where is Cystic Fibrosis coded to?

A

E84 - it is not in J because it is a congenital endocrine condition despite it’s large respiratory involvement

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5
Q

Bronchospasm

A

Not assigned with:
- Asthma
- Acute/Chronic Bronchitis/Bronchiolitis
- Obstructive Pulmonary Disease

Only required when underlying cause not documented

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6
Q

Mucus plug

A

Code assigned when treatment is directed at plug itself

Note this is a T code, look into external causes for this dealio!

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7
Q

Types of Pulmonary edema

A

Cardiogenic vs noncardiogenic

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8
Q

Cardiogenic pulmonary edema

A
  1. Acute cardiogenic pulmonary edema is a manifestation of :
    - I50.1 - left ventricular failure
    - I50.0 - Congestive heart failure
    Therefore not coded with them
  2. Pulmonary Edema in the presence of current heart disease is assumed to be cardiogenic. Associated with left ventricular failure I50.1 which is assigned
    - If heart failure described as congestive or decompensated in which case I50.0 assigned
  3. Pulmonary edema not included with:
    - acute myocardial infarction
    - other ischemic heart disease
    - chronic valvular disease
    - other heart conditions
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9
Q

Noncardiogenic Pulmonary Edema

A

Pulmonary edema due to external causes
- Therefore require external cause codes

  • When cause of noncardiogenic heart failure not known (not specified and not associated with cardiac disorders) code to J81 pulmonary oedema
    • Note this also includes chronic and pulmonary hypostasis
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10
Q

Plueral effusion

A

Usually considered manifestation of:
- pulmonary disease
- certain cardiac conditions
- other non-specific bs in text

Only code when additional dx studies or therapeutic interventions such as thoracocentesis or chest-tube drainage are required.
- if treatment only aimed at pleural effusion then MRDx obvs

DONT CODE PLEURAL EFFUSION IF ONLY NOTED ON XRAY REPORT

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11
Q

Purulent pleural effusion

A

i.e. when fluid is purulent code to empyema J86. ~ pyothorax

abscess pleura

Optional assignment of causative organism as type 3/OP

  • confirm if we make this distinction or not
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12
Q

malignant pleural effusion

A

classified as secondary neoplasm of pleura

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13
Q

Atelectasis

A

Code only assigned physician documents it as a clinical condition requiring investigation and management itself

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14
Q

Pneumothorax

A

Always coded as not inherent to other conditions.

Spontaneous nontraumatic pneumothorax J93

Traumatic Pneumothorax S27

Postprocedural pneumothorax addressed in chapter 28 of primer

atelectasis expected result of pneumothorax so not coded

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15
Q

H. influenza

A

Hemophilus influenza - a bacterial infection and not a virus. Should not be confused with viral infection influenza

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16
Q

Influenza

A

when dx simply influenza, virus not identified or when documented in terms such as “infuenza-like” or “ILI” a code from J11 assigned

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17
Q

Influenza type A

A

The coder should reference at some point the WHO global infuenza program at the start of the season to determine which type qualifies as Type A

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18
Q

Documentation of variant influenza strains or strains not recognized by WHO as seasonal

A

Should raise a flag with the coder and they should access the WHO Global Influenza program to confirm the classification

Cases of zoonotic or pandemic influenza as defined by WHO are classified to J09
+ additional code to identify pneumonia and other manifestations

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19
Q

Pneumonia

A

Code in order of precedence

  1. Causative agent
    - coder must not attempt to determine causative agent based on sputum culture
    - - physician must document this
  2. Anatomic Distribution
    - If xray clearly indicates involvement of entire lobe then code as lobar pneumonia
    - - may be described as:
    - - - apical
    - - - basilar
    - - - massive or complete consolidation of an entire lobe
  3. Mechanism
    - aspiration or hypostatic when ONLY the mechanism documented
    - - i.e. causative organism not documented
    - pneumonia associated with ventilator use
    - -assigned J95.88
    - - + additional code to describe type
    - - + external cause code Y84.8 procedure as cause the cause of….
    - - - search procedure to get to rubric!
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20
Q

Pneumonia with lung abscess

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A

classified to pneumonia code indicating causative agent

When not causative agent not known classified to J85.1 abscess of lung with pneumonia

21
Q

Pneumonitis

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A

Typically refers to inflammation of lung as a result of inhalation or exposure of lung to non-microorganisms.

When specific substances not IDed coded to J18.9

22
Q

Aspiration Pneumonia

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A

pneumonitis resulting from inhalation of foods, liquids, oils, vomit or microorganisms from upper respiratory tract or oropharyngeal area

Aspiration pneumonia classified to J69.^ pneumonitis due to…
- EXCEPT when due to microogranisms
- - Then coded to pneumonia by type of organism
- J69.^ requires external cause code

23
Q

Bronchitis

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A

When not specified as acute or chronic in pt under 15
- code to J20. acute
- - fourth char. infectious agent
- - - watch for combo codes

When not specified as acute or chronic in pt over 15
- code to J40 ~ bronchitis not specified
- - Bronchospasm assumed w/ bronchitis, therefore do not code with any bronchitis

24
Q

Asthma

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A

can be intrinsic, extrinsic or most commonly mixed

When not specified as any of above for asthma with onset during childhood (0-16) code to J45.0 ~ predominantly allergic asthma
- Search childhood as secondary terms

25
Status Asthmaticus
persistent severe asthma attack that does not respond to therapy. May be referred to as: - intractable asthma attack - refractory asthma - severe, intractable wheezing - airway obstruction not relieved by bronchodilators - acute severe asthma both acute and severe must be stated) - - fifth character indicating status asthmaticus only assigned when one of the above or status asthmaticus described by physician
26
Emphysema with chronic bronchitis, emphysematous bronchitis or any mention of COPD
Classified to J44.^ ~ other chronic obstructive pulmonary disease
27
Pt with emphysema not classifiable to J44 develop pneumothorax or respiratory infections
The pneumothorax or respiratory infection supersede emphysema as MRdx
28
COPD
Group of disorders coded to J44.0 including: - Chronic asthmatic bronchitis, - Chronic emphysematous bronchitis, - Chronic bronchitis with emphysema, - Chronic bronchitis with airway obstruction, - Chronic obstructive asthma, - Chronic obstructive bronchitis, - Chronic obstructive tracheobronchitis, - Emphysema with chronic obstructive bronchitis, - Chronic obstructive airway disease. NOTE: codes for asthma, chronic bronchitis and emphysema must not be assigned when condition classifiable to J44
29
Pt with COPD presents with lower respiratory tract infection being treated
Classify to J44.0 ~ chronic obstructive pulmonary disease with acute lower respiratory tract infection Use additional code for specific infectious condition - note since the condition is what is being treated it must be a comorbid dx type/OP. - COPD sequenced first If resp. Infection not being treated do not code apparently. Confirm in slides
30
COPD with acute exacerbations, with and without lower respiratory tract infection
acute exacerbation without lower respiratory tract infection coded to: - J44.1~COPD with acute exacerbation acute exacerbation with lower respiratory infetion coded to: - J44.0
31
COPD with acute exacerbation or lower respiratory infection leading to acute respiratory failure
additional code required for respiratory failure
32
Acute respiratory failure
ARF Code must be assigned as significant diagnosis when it is the reason for invasive ventilation - Assign code for underlying cause with a dx type depending on the circumstances in record
33
Acute respiratory distress syndrome
ARDS formerly called: - adults respiratory distress syndrome - acute lung injury (ALI) Occurs in children and adults and classified to: - J80 ~ adult respiratory distress syndrome In most cases underlying cause is the MRDX or comorbid condition. J80(ARDS) includes J96(ARF) therefore when both applicable code J80
34
Vaping-related disorders
- VALI - e-cigarette or vaping product use-associated lung injury (EVALI) - dabbing-related lung injury/damage and other similar terminology Coded to U07.0 vaping-related disorder Mandatory to assign when dx of any of above appears regardless of significance - additional codes for any manifestations of the disorder are also mandatory - - manifestations include - - - acute eosinophillic pneumonia - - - lipoid pneumonia - - - bronchiolitis obliterans organizing pneumonia (BOOP) - - - ARDS - - - pneumonitis
35
Documentation states pt vapes without dx of VALI or similar
Assign Z72.80 optionall as dx type3/OP do not assign U07.0 vaping-related disorder
36
Pleural centesis and pleural drainage
aka: thoracocentesis pleural tap chest tube drainage coded to: 1.GV.52.^^ ~ Drainage, pleura code assignment mandatory for DAD & NACRS IF chest tube drainage performed as part of chest closure following thoracic surgery it is not coded as it is a routine part of this procedure.
37
Pleural biopsy
Do not confuse with aspiration of pleural fluid. Pleural biopsy is minimally invasive and coded to 2.GV.71.HA Biopsy, pleura, using percutaneous (needle) approach
38
Invasive mechanical Ventilation
Classified to: 1.GZ.31.^^~ ventilation, respiratory system NEC with qualifier to indicate invasive v.s. non-invasive - - - - includes ventilation delivered through: - endotracheal intubation via nose or mouth - tracheostomy - percutaneous transluminal needle - - may be described as: - - - percutaneous dilational tracheostomy (PDT) - - - transtracheal jet - - - - additional code for 1.GJ.77.^^ ~ bypass wth exteriorization trachea required for tracheostomy or PDT
39
noninvasive mechanical ventilation
Classified to: 1.GZ.31.^^~ ventilation, respiratory system NEC with qualifier to indicate invasive v.s. non-invasive - - - - includes: - nasal prongs - face mask - - both w/o presence of intubation
40
Mechanical ventilation - DAD
1.non-invasive optional 2. invasive mandatory except!: - intraoperative ventilation when: - - ventilation is an inherent part of the administration of general anesthetic and when patient is extubated prior to leaving OR 3. Extent attribute required for all 1.GZ.31.^^ codes to indicate length of time pt required intubation - Number of hours calculated from time of initiation to time of final extubation -if pt intuated prior to admission, count begins @ admission - if pt transferred to a different facility or discharged count finishes at transfer time or discharge - Invasive intubation extends beyond time pt leaves OR, duration calculated from time of intubation in OR 4. When one method of invasive intubation changed to another, assign new code and calc duration separately for each 5. When Pt extubated and subsequently requires another episode of same invasive ventilation, record the episode with longest duration - - second episode coded optionally, calculate durations separately 6. status attribute mandatory to ID potential missed organ donors by denoting time from when last ventilation to death - use 0 when pt discharged alive - when multiple 1.GZ.31.^^ codes on abstract apply same mandatory status attribute value to each 7. Intervention pre-admit flag required when ventilation initiated prior to arrival in emergency or admission into inpatient facility
41
Mechanical ventilation - NACRS
1. Assignment of ventilation code mandatory except: - when noninvasive done as part of CPR 2. Extent attribute mandatory - when noninvasive use 0 3. status attribute mandatory to ID potential missed organ donors by denoting time from when last ventilation to death - use 0 when pt discharged alive - when multiple 1.GZ.31.^^ codes on abstract apply same mandatory status attribute value to each
42
Transbronchial needle aspiration (TBNA)
aka Fine Needle Aspiration - may occur with endobronchial ultrasound (EBUS) image assistance - - be sure to code separately - - - 3.GY.30.HE ~ Ultrasound, thoracic cavity NEC - - - - Lead: Ultrasound - - - - secondary: thoracic cavity
43
documentation describing "bronchoscopy with biopsy"
- Coder must determine if biopsy of lung or bronchus. - When biopsy taken at both sites, code both - When both tissue biopsy and brushings or washing taken at same site, tissue biopsy takes precedence
44
Mediastinal lymph nodes coded with other intrathoracic nodes
Coded to: - 2.ME.71.^^ ~Biopsy, lymph node(s), intrathoracic NEC
45
Lymph node biopsy
important to review nodes included at: 2.ME.^^ & 2.MF.^^ to ensure correct code selection
46
TBNA
Used for biopsy of: - lung - lymph nodes Review and clarify which structures are biopsied to ensure that separate codes are assigned for each anatomical site biopsied
47
Interventions on lungs
Important to note and pay careful attention to anatomical site. Location attribute mandatory for many rubrics at these two sites Therapeutic interventions confined to one lobe of the lung classified to: - 1.GR.^^ ~ therapeutic interventions on the lobe of lung Therapeutic interventions on lung as a whole or multiple overlapping sites coded to - 1.GT.^^ ~ therapeutic interventions on lung NEC IMPORTANT NOTE: RIGHT LUNG 3 lobes LEFT LUNG 2 lobes - therefore be mindful regarding total and partial excision w/ respect to left/right lobes Further note: Wedge resection & segmental resection classified to: - 1.GR.87.^^ excision partial, lobe of lung BUT! - wedge resection biopsy of lung classified to 2.GT.71.^^ ~ Biopsy, lung NEC
48
COPDE
Chronic obstructive pulmonary disease with exacerbation
49
Ventilation ex vs cn?
Ex is extended meaning greater than 96 hours (4days) Cn is continuous less than 96 hours

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