This article discusses the ICD-10 coding guidelines for six common respiratory conditions – sinusitis, pharyngitis, influenza, pneumonia, chronic obstructive pulmonary disease (COPD), and bronchitis. WebMD defines sinusitis as “an inflammation, or swelling, of the tissue lining the sinuses”.
CPT code 94640 describes treatment of acute airway obstruction with inhaled medication and/or the use of an inhalation treatment to induce sputum for diagnostic purposes. 5
Codes J00-J06 Acute upper respiratory infections J09-J18 Influenza and pneumonia J20-J22 Other acute lower respiratory infections J30-J39 Other diseases of upper respiratory tract J40-J47 Chronic lower respiratory diseases J60-J70 Lung diseases due to external agents J80-J84 Other respiratory diseases principally affecting the interstitium
facility, 94002 may be reported for the ventilator. Ventilation management CPT codes (94002-94004 and 94660) are not separately reportable with evaluation and management (E&M) CPT codes. If an E&M code and a ventilation management code are reported, only the E&M code is payable.
ICD-10 code R06. 83 for Snoring is a medical classification as listed by WHO under the range - Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified .
J20–J22, Other acute lower respiratory infections. J30–J39, Other diseases of upper respiratory infections. J40–J47, Chronic lower respiratory diseases. J60–J70, Lung diseases due to external agents.
ICD-10-CM Code for Acute respiratory distress R06. 03.
9.
9 Acute upper respiratory infection, unspecified.
9: Fever, unspecified.
Z20. 828, Contact with and (suspected) exposure to other viral communicable diseases. Use this code when you think a patient has been exposed to the novel coronavirus, but you're uncertain about whether to diagnose COVID-19 (i.e., test results are not available).
Two websites ( here and icdlist.com/icd-10/Z28.20 ) define the code “ICD 10 code Z28. 20” as “Immunization not carried out because of patient decision for unspecified reason.” It also covers other vaccines such as Tdap and polio.
R06. 03 - Acute respiratory distress | ICD-10-CM.
For example, Z12. 31 (Encounter for screening mammogram for malignant neoplasm of breast) is the correct code to use when you are ordering a routine mammogram for a patient.
For example, Z11. 52 will replace Z11. 59 (Encounter for screening for other viral diseases), which the CDC previously said should be used when patients being screened for COVID-19 have no symptoms, no known exposure to the virus, and test results that are either unknown or negative.
R53. 81: “R” codes are the family of codes related to "Symptoms, signs and other abnormal findings" - a bit of a catch-all category for "conditions not otherwise specified". R53. 81 is defined as chronic debility not specific to another diagnosis.
Therapeutic procedures whose principle aim is to treat a respiratory impairment should be identified using the G0237-G0239 series of HCPCS codes. CPT® codes 97000 to 97799 are not to be billed by professionals involved in treating respiratory conditions, unless these services are delivered by physical or occupational therapists and meet the other requirements for physical and occupational therapy services.
Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the article should be assumed to apply equally to all Revenue Codes.
Billing and Coding articles provide guidance for the related Local Coverage Determination (LCD) and assist providers in submitting correct claims for payment. Billing and Coding articles typically include CPT/HCPCS procedure codes, ICD-10-CM diagnosis codes, as well as Bill Type, Revenue, and CPT/HCPCS Modifier codes. The code lists in the article help explain which services (procedures) the related LCD applies to, the diagnosis codes for which the service is covered, or for which the service is not considered reasonable and necessary and therefore not covered.
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You, your employees and agents are authorized to use CPT only as contained in the following authorized materials of CMS internally within your organization within the United States for the sole use by yourself, employees and agents. Use is limited to use in Medicare, Medicaid or other programs administered by the Centers for Medicare and Medicaid Services (CMS). You agree to take all necessary steps to insure that your employees and agents abide by the terms of this agreement.
CPT codes, descriptions and other data only are copyright 2020 American Medical Association. American Medical Association. All Rights Reserved (or such other date of publication of CPT). CPT is a trademark of the American Medical Association (AMA).
Organizations who contract with CMS acknowledge that they may have a commercial CDT license with the ADA, and that use of CDT codes as permitted herein for the administration of CMS programs does not extend to any other programs or services the organization may administer and royalties dues for the use of the CDT codes are governed by their commercial license.
Clinics in Geriatric Medicine. 2003;19 (1):19-33. Describes that the prevalence of dyspnea in the elderly could be as high as 38% and raises the question of how much of this is related to obesity and deconditioning as opposed to actual pulmonary impairments.
diagnostic tests ordered by and for the evaluation by a physician or NPP (e.g., pulmonary function test, spirometry, and blood gas analyses etc.)
CPT is provided “as is” without warranty of any kind, either expressed or implied, including but not limited to, the implied warranties of merchantability and fitness for a particular purpose. AMA warrants that due to the nature of CPT, it does not manipulate or process dates, therefore there is no Year 2000 issue with CPT. AMA disclaims responsibility for any errors in CPT that may arise as a result of CPT being used in conjunction with any software and/or hardware system that is not Year 2000 compliant. No fee schedules, basic unit, relative values or related listings are included in CPT. The AMA does not directly or indirectly practice medicine or dispense medical services. The responsibility for the content of this file/product is with CMS and no endorsement by the AMA is intended or implied. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this file/product. This Agreement will terminate upon no upon notice if you violate its terms. The AMA is a third party beneficiary to this Agreement.
You, your employees and agents are authorized to use CPT only as contained in the following authorized materials of CMS internally within your organization within the United States for the sole use by yourself, employees and agents. Use is limited to use in Medicare, Medicaid or other programs administered by the Centers for Medicare and Medicaid Services (CMS). You agree to take all necessary steps to insure that your employees and agents abide by the terms of this agreement.
CPT codes, descriptions and other data only are copyright 2020 American Medical Association. American Medical Association. All Rights Reserved (or such other date of publication of CPT). CPT is a trademark of the American Medical Association (AMA).
Organizations who contract with CMS acknowledge that they may have a commercial CDT license with the ADA, and that use of CDT codes as permitted herein for the administration of CMS programs does not extend to any other programs or services the organization may administer and royalties dues for the use of the CDT codes are governed by their commercial license.
Canada adopted the new code set in 2000, and from there, several European countries as well as Thailand, Korea, China, and South Africa adopted ICD-10 in its original, modified, or translated form. Even Dubai made the switch in 2012.
Unspecified codes are available for the rare cases in which there is absolutely no other, more specific option. If a more specific option is available, you should use it.
The World Health Organization (WHO)—the public health sector of the United Nations that focuses on international health and outbreaks—started developing the ICD-10 coding system in 1983, but didn’t actually finish it until 1992. Yes, it took almost a decade to create ICD-10, and it has taken more than a decade for the US to actually put the final version of the code set to use.
So, what about ICD-10 makes it so much better than ICD-9? Well, the massive number of codes means that medical providers—including rehab therapists—can more accurately document clinical information, including patient diagnoses. Ultimately, that fosters:
For example, you could use Z51.89, encounter for other specified aftercare, or Z47.1, aftercare following joint replacement surgery. However, as this article notes, “you should not submit Z51.89 as a patient’s sole diagnosis—if you can help it—because on its own, this code might not adequately support the medical necessity of therapy treatment. Thus, using it as a primary diagnosis code could lead to claim denials.” In fact, whenever you use an aftercare code, you also should code for the underlying conditions/effects. For chronic or recurrent bone, muscle, or joint conditions, check out Chapter 13.
There, you’ll find directives such as “Use additional code” or “Code first” (“Code first” indicates you should code the underlying condition first). Also, keep in mind that there are single combination codes (i.e., one code that indicates multiple diagnoses) you can use to classify conditions that often occur simultaneously.
The short answer is “no.” Sure, ICD-10 helps healthcare providers better communicate detailed diagnostic information through codes. However, codes aren’t enough by themselves; providers must also continue to complete detailed documentation to support their code selection. According to CMS, “If complete information is not captured in clinical documentation, the result will be incomplete documentation for coding that then can impact revenues through delays, missed revenues, [and] outcome measures that don’t clearly or accurately reflect the quality and complexity of the care that is being delivered.”
Below is a list of common ICD-10 codes for Physical Therapy. This list of codes offers a great way to become more familiar with your most-used codes, but it's not meant to be comprehensive. If you'd like to build and manage your own custom lists, check out the Code Search!
You can play training games using common ICD-9/10 codes for Physical Therapy! When you do, you can compete against other players for the high score for each game. As you progress, you'll unlock more difficult levels! Play games like...