ICD-10 Update: J67.0 Changes Your Farmer's Lung Reporting in 2013

Use history as well as symptoms hand-in-hand to arrive at the correct diagnosis.

At present, in case your pulmonologist arrives at the diagnosis of farmer's lung, you are required to report it with the ICD-9 code 495.0 (Farmers' lung). When ICD-9 transforms to ICD-10 effective October 1, 2013, the ICD-10 code for farmers' lung will change to J67.0 (Farmer's lung). Though, the descriptor under ICD-10 will remain the same as in ICD-9. Read on for more on the condition and how to report it.

Clinical details: Hypersensitivity pneumonitis is also called extrinsic allergic alveolitis (EAA). EAA is a respiratory condition which is caused by a hypersensitivity reaction to inhaled extrinsic factors leading to inflammation in the alveoli of the lungs. This is an occupational hazard, and the classification of EAA is also decided on the grounds of the inhaled extrinsic factor.

One such sort of EAA is Farmer's lung. Farmer's lung is caused by inhalation of moldy hay particles or other agricultural dust particles contaminated by mold.

The inhalation of these particles will initially demonstrate type III hypersensitivity (immune-complex induced tissue injury) which results in inflammation of the alveoli. In case left unchecked or exposure constantly persists, it will lead to a chronic inflammatory condition.

ICD difference: Even though ICD-10 codes are aimed at improving the description of the diagnosis of diseases based on advancements in medical science, the descriptor for Farmers' lung remains unaffected under J67.0.

ICD-10 Medical Coding tips: Documentation of the signs as well as symptoms forms an integral part of the report while your pulmonologist considers the differential diagnoses of any kind of EAA.

A number of the commonly seen signs as well as symptoms that are essential to be reported and that you must look for in the note will include: fever (R50.9, Fever unspecified), fatigue (R53.83, Other fatigue), shortness of breath (R06.02, Shortness of breath), painful breathing (R07.1, Chest pain on breathing), anorexia (R63.0 and weight loss (R63.4, Abnormal weight loss).

However, in ICD-10 codes, to arrive at a definitive diagnosis of farmers' lung (or any other type of EAA), your pulmonologist will require a complete history, a thorough examination as well as the results of diagnostic tests, for instance bronchoscopy (31622 [Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; diagnostic, with cell washing, when performed (separate procedure)], 31623 [….with brushing or protected brushings], 31624 […..with bronchial alveolar lavage], 31628 […. with transbronchial lung biopsy(s), single lobe]) as well as pulmonary function tests (94010 [Spirometry, including graphic record, total and timed vital capacity, expiratory flow rate measurement(s), with or without maximal voluntary ventilation], 94727 [Gas dilution or washout for determination of lung volumes and, when performed, distribution of ventilation and closing volumes], 94375 [Respiratory flow volume loop], +94729 [Diffusing capacity (e.g., carbon monoxide, membrane)(List separately in addition to code for primary procedure)]).

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