ICD-10 coding challenge: Aspergillosis

Sue Belley is back from 3M's Client Experience Summit and catching up on her work. In the meantime, her colleague Julia Palmer, project manager with the consulting services business of 3M Health Information Systems, is handling this month's coding challenge blog.

CHALLENGE QUESTION

A 45 year-old male was admitted to the hospital after failed outpatient treatment for ongoing flu-like symptoms of fever, chills, dizziness, weight loss and severe cough with hemoptysis. The patient also has sarcoidosis of the lungs.

Blood work revealed positive serum immunoglobulin G antibodies to A. fumigates. CT scan revealed consolidation, pleural thickening and cavitary lesions in the lung lobes and a ball shape the size of a dime in his left lung which was ultimately diagnosed as an aspergilloma.

It was also determined through endoscopic left lower lobe lung biopsy via mouth that the aspergillus fungus was living in cavities in his lungs, literally eating away at the tissue, which in turn was causing his lungs to bleed. The cavities were caused by his sarcoidosis.

In addition to antifungal medications, treatment consisted of percutaneous embolization of the left bronchial artery using polyvinyl beads to stop bleeding and prevent formation of new blood vessels. It was determined that due to size and location, the aspergilloma could not be removed surgically.

The physician’s final diagnosis was chronic necrotizing aspergillosis and sarcoidosis of the lungs.

 Assign the appropriate ICD-10-CM and ICD-10-PCS codes for this scenario.

ANSWER

B441                     Other pulmonary aspergillosis

D860                    Sarcoidosis of lung

03LY3DZ            Occlusion, Upper Artery, Percutaneous, Intraluminal Device, No Qualifier

0BBJ8ZX            Excision (biopsy), Lower Lung Lobe, Left, Via Natural or Artificial Opening Endoscopic, No
                              Device, Diagnostic

BLOG

Can your pillow make you sick?

Well yes, your pillow can make you sick if it is contaminated with the fungus Aspergillus fumigatus. This common Aspergillus species can cause disease in people, particularly those with immune deficiencies, such as persons with AIDS, leukemia, sarcoidosis or transplant recipients. Aspergillus fumigatus can exacerbate asthma, has been linked to chronic sinusitis, and can cause allergic rhinitis and lower respiratory infections. A 2005 study by the University of Manchester found the fungus in both synthetic and feather pillows but significantly more was found in synthetic pillows. Apparently, the fungus feeds off the feces of dust mites. Ick! (My pillows are feather but they are in the washing machine as we speak!)

 We don’t know for certain what caused the chronic necrotizing aspergillosis in this month’s patient, but I’m wondering when he last washed his pillows?  Most people’s immune systems will wipe out the fungus; immunocompromised people are more vulnerable.

After reading about this month’s patient and the 2005 study, I was interested to see if there were any changes from ICD-9 to ICD-10 in the coding of Aspergillus related conditions. And yep, there are. ICD-10 cleaned up the classification rather nicely by expanding the codes for specificity and putting everything all in one place.

Julia Palmer is a project manager with the consulting services business of 3M Health Information Systems.