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re; subcutaneous emphysema

Lara Posted Mon 05th of April, 2010 15:39:07 PM

Hi,
I would like to know how would you code subcutaneous emphysema. There is two icd 9 code 958.7 for traumatic & one for 518.1 intersitital. The report states subcutaneous emphysema, but it's not stating traumatic. But if you look it up in the icd 9 code book it tells you to code 958.7. What do you guys think?

SuperCoder Answered Mon 05th of April, 2010 18:56:12 PM

As per Wikipedia.com. A Subcutaneous emphysema can result from puncture of parts of the respiratory or gastrointestinal systems. Particularly in the chest and neck, air may become trapped as a result of penetrating trauma (e.g., gunshot wounds or stab wounds) or blunt trauma. Infection (e.g., gas gangrene) can cause gas to be trapped in the subcutaneous tissues. Subcutaneous emphysema can be caused by medical procedures and medical conditions that cause the pressure in the alveoli of the lung to be higher than that in the tissues outside of them.[3] Its most common causes are pneumothorax and an improperly functioning chest tube.
So depending upon the reason for this emphysema, you can code either 998.91 or 958.7. Otherwise, please send me detail surgical history and present condition of patient.

Lara Posted Tue 06th of April, 2010 15:20:44 PM

Hi,

this is from the radiology report

CT chest, noncontrast

Indication: Pneumothorax and subcutaneous emphysema, reinsertion of
small caliber chest tube with Heimlich valve
Spiral CT of the chest was obtained without contrast. There is a right
pneumothorax of approximately 50% with extensive subcutaneous
emphysema.

The skin was marked, then prepped and draped in the usual sterile
fashion. Local anesthetic was injected through the chest wall. A small
incision was made to allow for passage of the Heimlich valve catheter.

The catheter was introduced and its position within the pleural space
was confirmed. Suction was applied. There was partial reinflation of
the right lung, and approximately 250 cc of serous fluid was removed.

The Heimlich valve appeared to be working However, the lung did not
completely expand on followup CT.

Impression:
Heimlich valve replacement with incomplete reexpansion of the right
lung. Extensive subcutaneous and mediastinal air is noted.

Severe bilateral interstitial and airspace disease persists.
<LCI>

SuperCoder Answered Wed 07th of April, 2010 06:20:37 AM

As per the report it indicates that the person had previously undergone through a surgical insertion procedure. The pneumothorax and subcutaneous emphysema might have occurred after this surgical procedure. Due to this reason the patient is coming for reinsertion of this small caliber chest tube with Heimlich valve. So in this case I would consider a surgical emphysema and would go with the code 998.81.
Also, apart from this, check the past medical records of the patient starting from the date of insertion to this reinsertion of valve, or you can further confirm from the physician.

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