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R91.8
ICD-10-CM
Lung Opacity

Find clear information on lung opacity diagnosis, including clinical documentation best practices, ICD-10 codes, differential diagnoses, and medical coding guidelines. Learn about common causes of lung opacities such as pneumonia, atelectasis, and lung cancer, along with relevant imaging findings like ground-glass opacities and consolidations. This resource provides valuable insights for healthcare professionals, medical coders, and CDI specialists seeking accurate and comprehensive information on pulmonary opacities.

Also known as

Pulmonary Opacity
Ground-Glass Opacity
GGO

Diagnosis Snapshot

Key Facts
  • Definition : A dense area in the lung tissue visible on X-ray or CT scan.
  • Clinical Signs : Cough, shortness of breath, fever, chest pain, and reduced oxygen levels.
  • Common Settings : Pneumonia, lung cancer, tuberculosis, and pulmonary edema.

Related ICD-10 Code Ranges

Complete code families applicable to AAPC R91.8 Coding
R09.0

Abnormal findings on diagnostic imaging

Includes abnormal lung opacity findings on X-ray or other imaging.

J12-J18

Pneumonia

Lung inflammation often causing opacity visible on imaging.

R91

Abnormal findings on diagnostic imaging of lung

Covers other abnormal lung imaging results, including opacities.

J80-J84

Respiratory conditions due to external agents

Lung reactions to external agents may produce imaging opacities.

Code-Specific Guidance

Decision Tree for

Follow this step-by-step guide to choose the correct ICD-10 code.

Is the lung opacity due to a specific infectious disease?

Code Comparison

Related Codes Comparison

When to use each related code

Description
Lung Opacity
Pneumonia
Pulmonary Edema

Documentation Best Practices

Documentation Checklist
  • Document opacity location, size, shape, and density.
  • Record symptom onset, duration, and character.
  • Detail associated symptoms like cough, fever, or dyspnea.
  • Note history of smoking, occupational exposures, or travel.
  • Document results of imaging studies and lab tests.

Coding and Audit Risks

Common Risks
  • Unspecified Opacity

    Coding lung opacity without further specification (e.g., location, etiology) leads to inaccurate DRG assignment and lost revenue.

  • Missed Co-morbidities

    Failing to document and code associated conditions (e.g., pneumonia, COPD) with lung opacity impacts severity and reimbursement.

  • Opacity Follow-up

    Lack of documentation clarifying the resolution or progression of a lung opacity creates audit risks and coding inconsistencies.

Mitigation Tips

Best Practices
  • Document opacity type, size, location for accurate ICD-10 coding.
  • Correlate imaging with clinical findings for CDI of pneumonia, atelectasis.
  • Query physician for clarification if opacity etiology is unclear for HCC coding.
  • Ensure complete documentation for compliant billing of radiology services.
  • Review prior imaging for comparison and trending of lung opacity changes.

Clinical Decision Support

Checklist
  • Review CXR/CT: Opacity location, size, shape?
  • Consider differentials: Infection, malignancy, other?
  • Check symptoms: Cough, fever, dyspnea, etc.?
  • Document opacity characteristics for ICD-10 coding.
  • Correlate imaging with clinical findings for patient safety.

Reimbursement and Quality Metrics

Impact Summary
  • Lung Opacity reimbursement hinges on accurate coding (ICD-10 R09.0) and documentation specifying etiology, impacting DRG assignment and payment.
  • Coding quality directly impacts lung opacity claims. Pneumonia (J18.9) miscoding leads to denials, affecting hospital revenue cycle.
  • Thorough documentation of lung opacity findings, including size and location, improves quality reporting metrics like severity and mortality.
  • Accurate lung opacity coding and staging influence hospital quality scores, impacting public reporting and potential value-based payments.

Streamline Your Medical Coding

Let S10.AI help you select the most accurate ICD-10 codes. Our AI-powered assistant ensures compliance and reduces coding errors.

Quick Tips

Practical Coding Tips
  • Code J18.0 for pneumonia
  • Document opacity type
  • Rale finding supports J18
  • Consider other J codes
  • Check laterality for coding

Documentation Templates

Patient presents with symptoms suggestive of a lung opacity, including cough, shortness of breath, and chest pain.  Physical examination reveals decreased breath sounds and possible dullness to percussion over the affected area.  Differential diagnosis includes pneumonia, pulmonary edema, lung cancer, atelectasis, pleural effusion, and interstitial lung disease.  Preliminary assessment suggests the lung opacity may be related to an infectious process, given the patient's recent upper respiratory infection.  Ordered chest X-ray to confirm the presence, location, and characteristics of the opacity.  Further evaluation with a CT scan of the chest may be necessary for better characterization and to rule out other potential causes, including malignancy.  Initial treatment plan includes antibiotics for suspected pneumonia.  Patient education provided regarding medication management, follow-up care, and warning signs of worsening respiratory distress.  Will continue to monitor patient's respiratory status and adjust treatment as needed.  ICD-10 codes for consideration include J18.9 (Pneumonia, unspecified organism), J80 (Acute respiratory distress syndrome), and R09.0 (Dyspnea).  CPT codes for billing may include 71010 (Chest X-ray, single view), 71020 (Chest X-ray, two views), and 71250 (CT scan of the chest without contrast).  Final diagnosis and treatment plan are pending further diagnostic testing and clinical evaluation.