Questions/Answers for ICD-10-CM Coding: Chapter 10 - Diseases of the Respiratory System

1.   When do you code acute respiratory failure as a secondary diagnosis?

Correct answer: When it occurs after admission, or if it is present on admission, but does not meet the definition of principal diagnosis.

2.   Pneumonia due to adenovirus. What ICD-10-CM code is reported?

Correct answer: J12.0

3.   A patient with decompensated COPD is admitted to the hospital with acute exacerbation of bronchial asthma. What diagnosis(es) code(s) is(are) reported?

Correct answer: J44.1, J45.901

4.   A patient has a history of MRSA. She has just been admitted with pneumonia due to staphylococcus aureus. What ICD-10-CM coding is reported?

Correct answer: J15.211, Z86.14

5.   A child with a history of reactive airway disease (RAD) was admitted to hospital with complaints of increased wheezing. Nebulizer treatments were not helping. After monitoring and additional treatments are given, breathing stabilized and he is kept overnight for observation. Documented diagnosis is RAD exacerbation. What ICD-10-CM coding is reported?

Correct answer: J45.901

6.   A patient came into the ED with shortness of breath and goes into respiratory failure. He was intubated and admitted to the hospital for acute respiratory failure. Chest X-ray shows he has pleural effusion. What ICD-10-CM coding is reported?

Correct answer: J96.00, J90

7.   A patient is admitted to the hospital for management of a respiratory infection diagnosed the previous week. Her condition has not improved, and her cough has increased with difficulty breathing. She has a long history of smoking. She currently smokes one pack a day and is dependent on cigarettes. She uses a bronchodilator for her COPD. The provider diagnoses acute bronchitis with COPD exacerbation. What ICD-10-CM coding is reported for this visit?

Correct answer: J44.0, J20.9, J44.1, F17.210

8.   A patient is admitted to the hospital for severe sepsis, pneumonia, and acute respiratory failure. What ICD-10-CM codes are reported.

Correct answers: A41.9, R65.20, J18.9, J96.00

9.   A patient is admitted to the hospital for severe sepsis, pneumonia, and acute respiratory failure. What ICD-10-CM code is the principal diagnosis?.

Correct answer: A41.9

10. A patient is admitted for treatment of bacterial pneumonia. They also have CKD stage 3 and hypertension. What ICD-10-CM Codes are reported?

Correct answers: N18.30, J15.9, I12.9

11. A patient is admitted with severe, persistent asthma exacerbation.

Correct answer: J45.51

Answer Rationales

Question 1

Rationale: According to ICD-10-CM guideline I.C.10.b.2, 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.

Question 2

Rationale

ICD-10-CM Alphabetic Index: Pneumonia > Adenoviral > J12.0. Verify in the Tabular List.

Question 3

Rationale: ICD-10-CM Alphabetic Index: Asthma, asthmatic (bronchial catarrh) (spasmodic) > with> chronic obstructive pulmonary disease > with > exacerbation (acute) > J44.1.

The code can also be located by looking for Disease > lung > obstructive (chronic) > with > acute > exacerbation NEC > J44.1.

There is an instructional note for category J44 to code also type of asthma, if applicable.

ICD-10-CM Alphabetic Index: Asthma (bronchial) > With > Exacerbation (acute) > J45.901. Verify code selection in the Tabular List.

Question 4

Rationale:

ICD-10-CM Alphabetic Index look for Pneumonia > staphylococcal (broncho) (lobar)/aureus (methicillin susceptible) (MSSA), which guides you to J15.211.

The patient also has a history of MRSA.

ICD-10-CM Alphabetic Index: History > Personal (of) > Methicillin resistant Staphylococcus aureus (MRSA) > Z86.14. Verify code selection in the Tabular List.

Question 5

Rationale:

ICD-10-CM Alphabetic Index: Disease, diseased > reactive airway > “see” Asthma.

Asthma, asthmatic > with > exacerbation (acute) J45.901.

Verify code selection in the Tabular List.

According to the ICD-10-CM guidelines, when a definitive diagnosis is known, the related symptoms are not coded.

Question 6

Rationale:

ICD-10-CM Alphabetic Index: Failure > respiration, respiratory > acute > J96.00. There is no documentation supporting hypercapnia or hypoxia, so the respiratory failure is unspecified, which is code J96.00.

ICD-10-CM Alphabetic Index: Effusion > pleura, pleurisy, pleuritic, pleuropericardial > J90.

Verify code selection in the Tabular List.

According to ICD-10-CM guideline I.C.10.b.1, acute respiratory failure can be principal diagnosis with another acute diagnosis if it is clear the respiratory failure was responsible for the patient being admitted. 

Question 7

Rationale:

ICD-10-CM Alphabetic Index: Disease, diseased > pulmonary > chronic obstructive > with > acute bronchitis J44.0.

In the Tabular List, there is an instructional note to code also to identify the infection. For this example, the infection is reported with a code from category code J20 Acute bronchitis. Because there is no indication of the infectious agent for the acute bronchitis, an unspecified code is used.

ICD-10-CM Alphabetic Index: Bronchitis > acute or subacute (with bronchospasm or obstruction) > J20.9.

Also code the COPD exacerbation.

ICD-10-CM Alphabetic Index: Disease, diseased > pulmonary > chronic obstructive > with> exacerbation (acute) > J44.1.

In the Tabular List category J44.1, there is an Exludes2 Note for J44.0, meaning the 2 codes can be reported together when documented.

In the Tabular List category J44 has a note to code also the type of asthma, which is not applicable to this case, so it is not coded.

Category J44 also has a note to report an additional code for use of or exposure to smoke. The patient is currently still smoking and is dependent on cigarettes.

 ICD-10-CM Alphabetic Index: Dependence (on) > Nicotine > Cigarettes > F17.210.

Verify code selection in the Tabular List.

Question 8/9

Rationale:

ICD-10-CM Alphabetic Index: Sepsis > A41.9

ICD-10-CM Alphabetic Index: Sepsis > Severe > R65.20

ICD-10-CM Alphabetic Index: Pneumonia > J18.9

ICD-10-CM Alphabetic Index: Failure > respiration, respiratory > acute > J96.00. There is no documentation supporting hypercapnia or hypoxia, so the respiratory failure is unspecified, which is code J96.00

Verify code selection in the Tabular List.

Chapter 1 Specific Coding Guidelines, 1.d.1)(b) and 1.d.4 provide sequencing rules. The systemic infection is coded first followed by codes for a local infection, severe sepsis, and any associated acute organ dysfunction.

Question 10

Rationale:

ICD-10-CM Alphabetic Index: Pneumonia > Bacterial > J15.9

ICD-10-CM Alphabetic Index: Hypertension > Kidney > With > Stage 1 through stage 4 CKD > I12.9

ICD-10-CM Alphabetic Index: Disease > Kidney > Chronic > Stage 3 > N18.30

Verify code selection in the Tabular List.

Question 11

Rationale:

ICD-10-CM Alphabetic Index: Asthma > Severe Persistent > With > Exacerbation (acute) > J45.51

Verify code selection in the Tabular List.