September 01, 2015
Area(s) of Interest: Patient Care Practice Management
CPR’s “Coding Corner” focuses on coding, compliance and documentation issues relating specifically to physician billing. This month’s tip comes from Peggy Silley, the Director of ICD-10 Development and Training for AAPC, a training and credentialing association for the business side of health care.
Codes for sinusitis are located in ICD-10-CM Chapter 10, Diseases of the Respiratory System (category J00-J99). There are important concepts to consider when documenting sinusitis; the selected codes will identify the affected sinus and time parameter (acute, chronic or recurrent).
When more than one sinus, but not all sinuses, are affected (pansinusitis), the codes for “other sinusitis” are to be assigned according to whether it is acute, recurrent or chronic. When the term Sinusitis with the subterms acute or chronic, affecting more than one sinus other than pansinusitis, is referenced in the Alphabetic Index, it sends the user to the other sinusitis codes J01, Acute; other sinusitis and J32 Chronic; other sinusitis.
- Acute sinusitis, recurrent sinusitis (includes abscess, empyema, infection, suppuration)
- Sinus affected
- Infectious organism
- Chronic sinusitis (includes abscess, empyema, infection, suppuration)
- Sinus affected
- Current use, history of, exposure to tobacco smoke
There are several instructional notes you must consider when applying the sinusitis codes. A note under category J01 Acute sinusitis states that an additional code (B95-B97) is used to identify the infectious agent, if known. Codes B95-B97 are secondary codes to identify Staphylococcus, Streptococcus or Enterococcus.
Example: Steven presents for a visit with facial pain. He said he had a cold last week with some nasal congestion and facial pain. His pain is primarily below the eyebrows. Upon examination, his frontal sinuses are tender to percussion and there is injection and erythema in the turbinates. He is diagnosed with acute frontal sinusitis:
J01.10 Acute frontal sinusitis, unspecified
Rationale: In this example, Steven presents with facial pain in the frontal sinuses. Based on the time parameter, this is considered acute.
An instructional note for category J32 Chronic sinusitis directs you to use an additional code to identify current, history of or exposure to tobacco/tobacco smoke.
- Exposure to environmental tobacco smoke (Z77.22)
- History of tobacco use (Z87.891)
- Occupational exposure to environmental tobacco smoke (Z57.31)
- Tobacco dependence (F17.-)
- Tobacco use (Z72.0)
Category J01 contains an Excludes2 that allows for reporting chronic sinusitis (J32.0-J32.8) in addition to acute sinusitis. Excludes II notes allow you to report both conditions where documentation supports both conditions as present, and where the category does not include a code for acute on chronic.
Case 1: Patient presents for consultation on his recurrent frontal and maxillary sinusitis. He was referred to the ear, nose and throat physician’s office after presenting to his pediatrician’s office for the fifth time in a year with this problem:
J01.81 Other acute recurrent sinusitis
Rationale: This example shows that the sinusitis has had five episodes in the past year, which is considered to be recurrent. Also, based on the lookup of sinusitis in more than one location, J01.81 other sinusitis is used.
Case 2: Subjective: Janice is seen in the office for discomfort in the maxillary region. For the previous four to five years, the patient had suffered from chronic sinus problems of a similar type. Symptoms include constant nasal congestion, coughing and snoring. The patient is exposed to secondhand smoke from family members.
Objective: An initial exam showed edematous red nasal mucosa and colored nasal discharge. Allergy testing results were negative. A CT scan confirmed bilateral maxillary blockage and bilateral thickening of the mucus membrane.
Assessment: Chronic maxillary sinusitis, Secondary tobacco smoke exposure:
J32.0 Chronic maxillary sinusitis
Z77.22 Contact with and (suspected) exposure to environmental tobacco smoke (acute) (chronic)
Rationale: Because the patient is experiencing discomfort in the maxillary region, and chronic sinusitis for four to five years, this is considered to be chronic maxillary sinusitis. She is also exposed to secondhand smoke.