Pulmonary Edema – Diagnosis, Treatment and ICD-10 Codes

Pulmonary edema is a condition that occurs when excess fluid accumulates in the numerous air sacs in the lungs – the alveoli – making it difficult to breathe. This process interferes with gas exchange and causes respiratory failure. Also known as lung congestion or pulmonary congestion, this condition may be caused by a number of cardiac or non-cardiac conditions. Breathing difficulty is the main manifestation of pulmonary edema. In most cases, heart problems cause pulmonary edema. However, fluid can also accumulate for other reasons, including exposure to certain harmful toxins, medications, trauma to the chest wall and exercising at high elevations. Pulmonary edema can be either acute or fatal, but the outlook improves if a person gets treated quickly. Treatment for this condition varies depending on the cause, but generally includes supplemental oxygen and medications. Coders in companies offering reliable coding and physician billing services need to have thorough knowledge about the various causes and symptoms, which is essential to assign the right ICD-10 codes to report a pulmonary edema diagnosis.

Congestive heart failure (CHF) is one of the most common causes of pulmonary edema. Heart failure occurs when the heart can no longer pump blood properly throughout the body. This in turn creates a backup of pressure in the small blood vessels of the lungs, causing the blood vessels to leak fluid. Related medical conditions that cause pulmonary edema include – damaged heart valves, sudden high blood pressure, pneumonia, kidney failure, lung damage (caused by severe infection) and severe sepsis of the blood.

Symptoms and Treatment for Pulmonary Edema

The signs and symptoms may appear suddenly or develop over time, depending on the relative causes and the type of pulmonary edema. There are two different types - long-term pulmonary edema and high altitude pulmonary edema. Long-term pulmonary edema symptoms include – shortness/difficulty in breathing, wheezing, rapid weight gain, (especially in the legs), fatigue and swelling in the lower part of the body. On the other hand, high altitude pulmonary edema occurs due to altitude sickness or not getting enough oxygen in the air and presents with symptoms like headache, irregular/rapid heartbeat, fever, cough and shortness of breath after exertion and during rest.

Physicians will begin the diagnosis by looking for fluid in the lungs or symptoms caused by its presence. A basic physical examination will be performed to check for heartbeat, rapid breathing, a crackling sound or any abnormal heart sounds. Physicians may also check the patient’s neck for fluid buildup, legs and abdomen for swelling and check for pale colored skin. They will evaluate the symptoms and conduct a detailed review of medical history. Other additional tests include – complete blood count test (to check for oxygen levels), chest X-ray, Echocardiogram (to check for abnormal heart activity), Ultrasound and Electrocardiogram (ECG) to look for heart rhythm problems or any signs of a heart attack.

Giving oxygen is the first step in the treatment for pulmonary edema. Patients will receive oxygen through a face mask or nasal cannula. Delivering oxygen to each nostril will help ease the symptoms. Treatment for the condition involves medications like – Diuretics, Morphine (MS Contin), Preload and Afterload reducers and other blood pressure medications. However, in severe cases, people with pulmonary edema may need intensive or critical care. Physicians, who diagnose, screen and treat different types of pulmonary edema, must carefully document these tests and procedures using the correct medical codes. Billing and coding services provided by established medical billing and coding companies can help physicians in using the correct codes for their medical billing process.

In ICD-10-CM, code J81 and its sub-categories offer more specific representation of the different type of edema –

• J81 - Pulmonary edema
• J81.0 - Acute pulmonary edema
• J81.1 - Chronic pulmonary edema

There is no way to fully prevent pulmonary edema. However, avoiding conditions and situations that cause pulmonary edema can prevent the condition from developing. These preventive measures include – controlling blood pressure and blood cholesterol levels, maintaining a healthy body weight, reducing the intake of salt, doing regular body exercise and quitting the habit of smoking. In addition, getting pneumonia and flu vaccines at the correct time can also help control the occurrence of the symptoms of pulmonary edema.

The outlook for pulmonary edema depends on the severity of the condition. Patients who suffer a moderate case of pulmonary edema and receive quick treatment will often have a full recovery.

OSI provides RCM services for dental and medical practices of all sizes and specialties. Services include billing, insurance verifications, prior authorizations, coding, A/R management and more.