SINUSITIS AND BRONCHITIS Beth Sassano CPCI CPC CPMA
SINUSITIS AND BRONCHITIS Beth Sassano CPC-I, CPC, CPMA, CCS-P
EPIDEMIOLOGY Sinusitis is a common condition, with between 24– 31 million cases occurring in the United States annually. Chronic sinusitis affects approximately 12. 5% of people. Web. MD defines sinusitis as “an inflammation, or swelling, of the tissue lining the sinuses”.
PER WIKIPEDIA: Recurrent acute rhinosinusitis – Four or more separate episodes of acute sinusitis that occur within one year Subacute rhinosinusitis – An infection that lasts between four and 12 weeks, and represents a transition between acute and chronic infection Chronic rhinosinusitis – When the signs and symptoms last for more than 12 weeks. Acute exacerbation of chronic rhinosinusitis – When the signs and symptoms of chronic rhinosinusitis exacerbate, but return to baseline after treatment All these types of sinusitis have similar symptoms, and are thus often difficult to distinguish. Acute sinusitis is very common. Roughly ninety percent of adults have had sinusitis at some point in their life
CHAPTER 10 CD-10 -CM codes for sinusitis are found in chapter 10, Diseases of the Respiratory System, which includes codes J 00 -J 99. ICD-10 -CM instructional notes at the beginning of the chapter tell you to use an additional code (when applicable) 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
CHAPTER There are two Excludes notes: Excludes 1 note: States not to use these codes to describe sinusitis, not otherwise specified (NOS), which would be coded as J 32. 9 Chronic sinusitis, unspecified. Excludes 2 note: States that if the patient also has documented chronic sinusitis, it should be coded in addition to the code for the acute condition.
ACUTE SINUSITIS It is difficult to distinguish between bacterial and viral sinusitis. However, if symptoms last less than 10 days, it is generally considered viral sinusitis. When symptoms last more than 10 days, it is considered bacterial sinusitis.
ACUTE SINUSITIS J 01 Acute sinusitis J 01. 0 Acute maxillary sinusitis J 01. 00 …… unspecified J 01. 01 Acute recurrent maxillary sinusitis J 01. 1 Acute frontal sinusitis J 01. 10 …… unspecified J 01. 11 Acute recurrent frontal sinusitis J 01. 2 Acute ethmoidal sinusitis J 01. 20 …… unspecified J 01. 21 Acute recurrent ethmoidal sinusitis J 01. 3 Acute sphenoidal sinusitis J 01. 30 …… unspecified J 01. 31 Acute recurrent sphenoidal sinusitis J 01. 4 Acute pansinusitis J 01. 40 …… unspecified J 01. 41 Acute recurrent pansinusitis J 01. 8 Other acute sinusitis J 01. 80 Other acute sinusitis J 01. 81 Other acute recurrent sinusitis J 01. 9 Acute sinusitis, unspecified J 01. 90 Acute sinusitis, unspecified J 01. 91 Acute recurrent sinusitis, unspecified
ACUTE SINUSITIS J 01 Use Additional code (B 95 -B 97) to identify infectious agent. Type 1 Excludes sinusitis NOS (J 32. 9) Type 2 Excludes chronic sinusitis (J 32. 0 -J 32. 8) Includes acute abscess of sinus acute empyema of sinus acute infection of sinus acute inflammation of sinus acute suppuration of sinus
CHRONIC SINUSITIS Clinical Information: Inflammation of the paranasal sinuses that typically lasts beyond eight weeks (most references say 12 weeks). It is caused by infections, allergies, and the presence of sinus polyps or deviated septum. Signs and symptoms include headache, nasal discharge, swelling in the face, dizziness, and breathing difficulties.
CHRONIC SINUSITIS For sinusitis lasting more than 12 weeks a CT is recommended. Nasal endoscopy is also used to make a positive diagnosis. A nasal endoscopy involves inserting a flexible fiber-optic tube with a light and camera at its tip into the nose to examine the nasal passages and sinuses. This is generally painless (admittedly uncomfortable) procedure which takes between five to ten minutes to complete. A tissue sample for histology and/or cultures can also be collected and tested. Allergic fungal sinusitis (AFS) is often seen in people with asthma and nasal polyps.
SINUSITIS BY LOCATION By location (per Wikipedia) “There are several paired paranasal sinuses, including the frontal, ethmoidal, maxillary and sphenoidal sinuses. The ethmoidal sinuses is further subdivided into anterior and posterior ethmoid sinuses, the division of which is defined as the basal lamella of the middle turbinate. In addition to the severity of disease, sinusitis can be classified by the sinus cavity which it affects:
DOCUMENT SINUSITIS BY LOCATION (WIKIPEDIA) Maxillary Sinusitis – can cause pain or pressure in the maxillary (cheek) area or headache (J 01. 0/J 32. 0) Frontal – can cause pain or pressure in the frontal cavity (located above eyes), headache, particularly in the forehead (J 01. 1/J 32. 1) Ethmoidal – can cause pain or pressure pain between/behind the eyes, the sides of the upper part of the nose, and headaches (J 01. 2/J 32. 2) Sphenoidal – can cause pain or pressure behind the eyes, but often refers to the top of the head, or the back of the head.
DOCUMENTATION FOR BRONCHITIS SAND SINUSITIS As you can tell provider documentation will need to be concise. Document Acuity: � Acute � Chronic � Acute on chronic
ACUTE BRONCHITIS Acute Bronchitis is an inflammation of the bronchial tubes, the airways that carry air to your lungs. It causes a cough that often brings up mucus. Shortness of breath, wheezing, and chest tightness are also symptoms. There are two main types of bronchitis, acute and chronic. The same viruses that cause colds and the flu often cause acute bronchitis. These viruses spread through the air when people cough, or through physical contact.
ACUTE & CHRONIC BRONCHITIS Being exposed to tobacco smoke, air pollution, dust, vapors, and certain fumes can cause acute and/or chronic bronchitis. Bacteria can also cause acute bronchitis, but not as often as viruses. Most cases of acute bronchitis improve within several days. But a cough can last for several weeks after the infection is gone. Inhaled medication may be needed to open airways if the patient is wheezing. Antibiotics do not work against viruses which is the most common cause of acute bronchitis. Chronic bronchitis - is defined as a productive cough that lasts for three months or more per year for at least two years. Most people with chronic bronchitis have chronic obstructive pulmonary disease (COPD
ACUTE EXACERBATION OF CHRONIC OBSTRUCTIVE BRONCHITIS AND ASTHMA Per the guidelines in chapter 10: The codes in categories J 44 and J 45 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
INCLUDE NOTES WHEN REVIEWING BRONCHITIS CODES Includes acute and subacute bronchitis (with) bronchospasm acute and subacute bronchitis (with) tracheitis acute and subacute bronchitis (with) tracheobronchitis, acute and subacute fibrinous bronchitis acute and subacute membranous bronchitis acute and subacute purulent bronchitis acute and subacute septic bronchitis
EXCLUDE 1 NOTE Means Not Coded Here! Type 1 Excludes bronchitis NOS (J 40) tracheobronchitis NOS (J 40)
EXCLUDE II NOTE acute bronchitis with bronchiectasis (J 47. 0) acute bronchitis with chronic obstructive asthma (J 44. 0) acute bronchitis with chronic obstructive pulmonary disease (J 44. 0) allergic bronchitis NOS (J 45. 909 -) bronchitis due to chemicals, fumes and vapors (J 68. 0) chronic bronchitis NOS (J 42) chronic mucopurulent bronchitis (J 41. 1) chronic obstructive bronchitis (J 44. -) chronic obstructive tracheobronchitis (J 44. -) chronic simple bronchitis (J 41. 0) chronic tracheobronchitis (J 42)
DETAILED DOCUMENTATION NEEDED FOR ACUTE BRONCHITIS TO IDENTIFY SPECIFICS OF THE CONDITION: J 20 Acute bronchitis J 20. 0 Acute bronchitis due to Mycoplasma pneumoniae J 20. 1 Acute bronchitis due to Hemophilus influenzae J 20. 2 Acute bronchitis due to streptococcus J 20. 3 Acute bronchitis due to coxsackievirus J 20. 4 Acute bronchitis due to parainfluenza virus J 20. 5 Acute bronchitis due to respiratory syncytial virus J 20. 6 Acute bronchitis due to rhinovirus J 20. 7 Acute bronchitis due to echovirus J 20. 8 Acute bronchitis due to other specified organisms J 20. 9 Acute bronchitis, unspecified
COPD ICD-10 added a code for a common acute exacerbation that brings a patient with COPD back to the provider’s office. COPD with acute lower respiratory infection such as acute bronchitis or pneumonia. The specific pneumonia or bronchitis code should be coded in addition to COPD. Documentation needs to support the code used: J 44. 0 Chronic obstructive pulmonary disease with acute lower respiratory infection. As with ICD-9, there is an ICD-10 code for COPD with exacerbation, which captures “decompensated” COPD, without any additional documentation. J 44. 1 Chronic obstructive pulmonary disease with (acute) exacerbation � Replaces 491. 21 Obstructive chronic bronchitis with (acute) exacerbation 493. 22 Chronic obstructive asthma with (acute) exacerbation
COPD There is an unspecified option, which no longer confuses us about whether the COPD is predominantly asthma or predominantly bronchitis — it’s just COPD. J 44. 9 Chronic obstructive pulmonary disease, unspecified Replaces � 491. 20 Obstructive chronic bronchitis without exacerbation 493. 20 Chronic obstructive asthma, unspecified 496 Chronic airway obstruction, not elsewhere classified
QUESTIONS?
REFERENCES 2014 Family Practice Management 2015 Children’s Healthcare of Atlanta ICD-10 data. com Rhonda Butler ICD-10 3 M
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