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ICD-10 Update: Turn to J Codes With Minor Descriptor Changes For Pyothorax



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Your work as a pulmonology coder might expose you to see a number of different infections of the lungs and the pleural cavity, leading to a diagnosis of pyothorax (empyema).
ICD9 Codes, ICD-10

Tip: Watch for fistula as in the ICD-9 codes.

Your work as a pulmonology coder might expose you to see a number of different infections of the lungs and the pleural cavity, leading to a diagnosis of pyothorax (empyema). For this reason, you need to be well informed about how the ICD-9 codes change while reporting pyothorax (empyema) when ICD 10 codes come into effect.

While your pulmonologist makes a diagnosis of pyothorax (empyema), you will time and again see the following in the documentation of the patient:

Symptoms for instance fever (R50.9, Fever, unspecified); cough (R05, Cough); shortness of breath (R06.02, Shortness of breath); pain in the area of the chest (R07.1, Chest pain on breathing); and sweating (R61, Generalized hyperhidrosis).

Your pulmonologist will order for a chest x-ray or a CT scan of the chest to check what is leading to the symptoms as well as determine the changes in breath sounds that he will encounter in the examination of the patient.

Standard 2-view chest x-ray remains the first study for assessing empyema. Ultrasonography may indicate small volumes of pleural fluid. It may also deliver info about viscosity or quickly determine septa in the pleural fluid collection. Chest CT offers the most information. CT imaging identifies fluid, loculation, and thickening of the pleural membranes. CT and ultrasonography are also used in the placement of drainage catheters.

In case the chest x-ray or the CT scan demonstrates signs of pus accumulation in the pleural space, your pulmonologist will carry out a thoracentesis to take out the pus from the pleural space. You will report this procedure with 32422 (Thoracentesis with the insertion of the tube, includes water seal (e.g., for pneumothorax), when performed [separate procedure]).

After that, the removed fluid is sent to the laboratory for culture and to check in case the accumulated fluid is exudative (caused due to an infection such as pneumonia) or transudative (caused due to organ failure).

In case the consequences of the fluid return back as exudative, your pulmonologist confirms a diagnosis of pyothorax (empyema).

Reporting Pyothorax with ICD-9 Codes

While your pulmonologist confirms a diagnosis of pyothorax, you are required to look further in the documentation to check in case there is a mention of a fistula in the patient’s notes. Based on the presence or absence of a fistula, pyothorax (empyema) is reported with ICD-9 codes as listed below:

  • 510.0 – (Empyema with fistula. This code includes bronchocutaneous fistula, bronchopleural fistula, hepatopleural fistula, mediastinal fistula, pleural fistula, thoracic fistula and any condition classifiable to 510.9 with fistula)
  • 510.9 – (Empyema without fistula. This code includes abscess of pleura, abscess of thorax, empyema (chest, lung or pleura), fibrinopurulent pleurisy, purulent pleurisy, pyopneumothorax, septic pleurisy, seropurulent pleurisy, and suppurative pleurisy)

Observe Fistula Descriptor Changes in ICD-10 Codes

When ICD-10 hits, you will report a diagnosis of pyothorax (empyema) on a similar basis that you were using for ICD-9 codes, i.e. you look for presence or absence of a fistula in the documentation of the patient. Based on this, you will report pyothorax with ICD-10 codes as listed below:

  • J86.0 – (Pyothorax with fistula)
  • J86.9 – (Pyothorax without fistula)

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