Question

how will understanding the respiratory system help with completing billing and coding task?

Answer 1

The respiratory system is, obviously, how we breathe. Air enters into our body through our nose or mouth. When it enters through out nose, it travels through the nasal cavity and into the nasopharynx. When it enters through the mouth, it travels into the oropharynx (think “oral” = oro).

The two pharynxes meet in the oropharynx, and air then travels down the esophagus and the larynx, through the trachea, and into the bronchi (singular: bronchus), which are tree-like sets of tubes that extend into each lung. The trachea meets the bronchi at a point called the carina. Each bronchus divides into a set of smaller tubes, known as the bronchiole. Those tubes terminate in hollow sacs called alveoli. Each lung is made up of lobes. The right lung has three lobes, while the left has two.

The procedure codes are laid out just like the structure of the respiratory system. Toward the front of the subsection you’ll find codes for procedures on the nose, including the removal of foreign bodies, and reconstructive surgery like rhinoplasties. You’ll also find procedures on the sinuses in this part of the respiratory subsection.

Following the nose and nasal passages, you’ll find a procedures on the trachea and bronchi, including exploratory surgery (with endoscopy), excision, and repair (such as “carinal repair”).

The final and largest area of the respiratory system subsection is that of the lungs and pleura. The pleura are a set of membranes that cover the lungs. The parietal pleura coats the lungs on the outside, and separates them from the chest cavity. The visceral pleura is situated between the parietal pleura and the lung itself.

Under lung and pleura you’ll find codes for incision, excision, resection, removal, and exploration of the lung and pleura. You’ll also find codes for video-assisted thoracic surgery (VATS) procedures. You’ll also find codes for transplantation. These, like other transplantation or graft codes, have guidelines for coding where the donor lung came from. That is, is the lung coming from a cadaver or a live donor.

With the increase in oversight and the continuous pressure to provide healthcare services in the most cost-efficient method, it’s necessary to thoroughly understand the current reimbursement system to maintain an active and financially healthy practice. Physician services are routinely submitted to third-party payers in alpha- numerical as well as numerical codes for appropriate compensation.

This alpha numerical and numerical coding system is a translation of the information documented in the medical record. The purpose of this translation is appropriate compensation for the healthcare provider as well as data collection for analysis by the healthcare systems for all patients and their diseases. With HIPAA, documentation of the patient encounters is mandatory o justify the codes submitted to third-party payers for reimbursement. This applies not only to Medicare but to all other insurance carriers throughout the country. Therefore, documentation of the encounter with the patient is now not only important for good patient care, but also for third-party reimbursement and utilization of healthcare dollars.

SPECIFIC CATEGORY CODE BLOCKS

• 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
• J85–J86, Suppurative and necrotic conditions of the lower respiratory tract
• J90–J94, Other diseases of the pleura
• J95, Intraoperative and postprocedural complications and disorders of respiratory system, not elsewhere classified
• J96–J99, Other diseases of the respiratory system