Q&A: Aspiration pneumonia sequencing in ICD-10-CM

Q: A 64-year-old female bilateral lung transplant recipient presents with aspiration pneumonia, hypoxia, and has immunosuppression from the drugs. How would this scenario be reported in ICD-10-CM?

A: Sequenced correctly, the scenario would be reported as follows:

• Primary diagnosis: T86.818, other complication of lung transplant
• MCC: J69.0, pneumonitis due to inhalation of food and vomit
• CC:
  
  • D84.821, immunodeficiency due to drugs
  • R09.02, hypoxemia

Being unaware of the rules, a coder would be tempted to report the pneumonia code first and then the transplant status and various other codes. But knowing the rules, the coder would report the lung transplant infection first.

Coding Clinic, second quarter 2019, features a similar situation about aspiration pneumonia. A patient with a previous bilateral lung transplant presents with aspiration pneumonia due to emesis with a continuous positive airway pressure (CPAP) mask. The inquirer asks what the correct code assignment would be.

Coding Clinic directs the coder to assign code T86.818 (other complications of lung transplant), then J89.0 (pneumonitis due to inhalation of food and vomit).

At first, coders might think, “What? ‘Other complication’? Not the infection?”

No, because aspiration pneumonia is considered mechanical pneumonia. It certainly can cause an infection. And if the provider documents bacterial, fungal, or viral infection of the lung, that will also be coded along with the aspiration code.

However, that is not happening in this scenario. With documentation of only aspiration pneumonia, the coder would assign “other complication,” and not an infection of the lung transplant.

So, now that we know our rules about this, the coder is going to follow that coding guideline and use the “other complication” code of the lung transplant with code T86.818.

The coder would report aspiration pneumonia with code J69.0 to specify which type of complication, as the 2024 ICD-10-CM guidelines, section I.C.19.g.3.a, state that: “Two codes are required to fully describe a transplant complication: the appropriate code from category T86 [complication of transplanted organs and tissue] and a secondary code that identifies the complication.”

Then, the coder would report the immunosuppression from drugs and hypoxia. The MS-DRG would be 205 (other respiratory system diagnosis with MCC).

Editor’s note: Penny Cassady, RN, CCDS, a CDI auditor and educator based in Houston, Texas, answered this question during the HCPro webinar “It's Complicated: Capturing Transplant Complication Codes.” Her answer was originally republished in JustCoding, which you can find here.