In Part 1 of this series, we reviewed ICD-10-CM code I77.1 and explained that there are some often overlooked conditions that increase your risk adjusted payments. This time, we’ll focus on ICD-10-CM code J84.10, Pulmonary fibrosis, unspecified. This code was added to the CMS-HCC model pretty late in the game (~2014) and encompasses several conditions, such as – obviously – pulmonary fibrosis, with no other specification or if described as familial, post-inflammatory or interstitial.
But it also includes granuloma of the lung, the most common type of lung tissue calcification. This condition is generally an incidental and asymptomatic radiological finding, but the risk adjustment model includes it as a weighted code. The Mayo Clinic defines a granuloma as a small inflammation that is typically noncancerous. Granulomas seem to occur in areas that have seen some sort of infection, bacteria or fungus, and result from the immune system’s attempt to isolate or encapsulate an “invader.”
Granulomas can occur in many areas of the body, but they generally are not risk adjusted conditions; in the lung, they are, and they can be found on x-rays and CT scans. If you’re tempted to believe these largely asymptomatic findings require scant support in the note, guess again. Clinicians should document an assessment that includes the evidence supporting the finding and any treatment or follow-up recommended, like they would for any other medical condition.
The most common question we get about granulomas is whether calcified granulomas “count.” The code J84.10 encompasses any granuloma of the lung.
See you for Part 3 of this series when we look at J47.9.