Sarcoidosis Diagnosis and Coding – An Overview of ICD-10 Codes

Sarcoidosis Diagnosis and Coding – An Overview of ICD-10 Codes

Sarcoidosis is the growth of tiny inflammatory cells (granulomas) in different parts of your body — most commonly the lungs, lymph nodes, eyes and skin. All symptoms of sarcoidosis must be documented with correct ICD-10 codes to prevent claim denials.

Sarcoidosis is an inflammatory disease where in granulomas or clumps of inflammatory cells (that cause small patches of red and swollen tissue) get developed in different parts or organs of the body. The areas of the body commonly affected by sarcoidosis include - lymph nodes, lungs, eyes and skin. Even though less common, sarcoidosis can also affect the heart, liver, brain and spleen. The exact cause of sarcoidosis is unknown. The condition may be triggered by your body’s immune system responding to substances such as viruses, bacteria, dust or chemicals. However, gender, race and genetics can increase the potential risk of developing this condition.

As sarcoidosis

progresses, microscopic

lumps of a

specific

form of

inflammation, called granulomas, appear in the affected tissues. In most of the cases, these granulomas clear up, either with or without treatment. On the other hand, in some cases, where in the granulomas do not heal and disappear, the tissues tend to remain inflamed, become scarred (fibrotic) and cause organ damage. Early and accurate diagnosis of sarcoidosis is challenging, as many patients are asymptomatic. Even when symptoms do occur (in some cases), they mimic those of other disorders. Prognosis is variable and may depend on epidemiologic factors, mode of onset, initial clinical course, and specific organ involvement. With appropriate and timely treatment combined with simple lifestyle changes and medications, it is possible to control the pain of disease flare-ups. For accurate clinical documentation of this disorder, physicians can benefit from the services of medical billing outsourcing companies.

What Are the Symptoms of Sarcoidosis?

The signs and symptoms associated with this condition may vary depending on which organs are affected or involved. For some people, the symptoms may develop suddenly, but disappear within a few months or years and the condition doesn't come back. On the other hand, for some people symptoms

develop gradually, last for years and get worse over time. Many people don’t even depict any symptoms at all, and the condition may be diagnosed after an X-ray carried out for another reason. For many people, sarcoidosis begins with the following general symptoms – 

Fatigue



Fever



Swollen lymph nodes



Weight loss



Tiredness and a general feeling of being unwell



Painful joints



Pain in the bones

Lung symptoms 

Persistent dry cough



Shortness of breath



Wheezing



Chest pain



Fainting (syncope)



Irregular heartbeats



Rapid or fluttering heart beat

Skin symptoms 

Blurred vision



Eye pain



Severe redness



Sensitivity to light



A rash of red or reddish-purple bumps (usually located on the shins or ankles)



Disfiguring sores (lesions) on the nose, cheeks and ears



Areas of skin (darker or lighter in color)



Growths under the skin (nodules), particularly around scars or tattoos

Eye symptoms 

Dry or itchy eyes



A burning sensation in your eyes



A discharge from your eyes

Sarcoidosis can affect people of any age group, but symptoms normally appear in people between the age group of 20- 40 years. It is more common in women than men. This condition rarely occurs in children.

Diagnosing and Coding for Sarcoidosis Diagnosing sarcoidosis is a very difficult process as the immediate signs and symptoms can be similar to those of other diseases. Physicians need to run a variety of tests to make a correct diagnosis about the disorder. The initial part of the diagnosis will most likely begin with a detailed physical examination (including a close examination of any skin lesions). The detailed physical exam will help to check – 

For skin bumps or a rash



For an enlarged liver or spleen



Look for swollen lymph nodes



Listen to heart and lungs

Based on these findings, physicians may conduct additional diagnostic tests like - Chest X-ray (to find for granulomas and swollen lymph nodes), Computerized tomography (CT scan), Lung (pulmonary) function tests, Positron emission tomography (PET) scan or Magnetic resonance imaging (MRI) (to check if sarcoidosis is affecting your heart or central nervous system) and biopsies (taking a sample of tissue to check for granulomas). In

addition, physician may conduct blood tests to check for kidney and liver function.

Most cases of sarcoidosis don't require treatment as the condition often goes away on its own, usually within a few months or years. Simple lifestyle changes and over-the-counter medications can help to control the symptoms in a better manner. Pulmonologists providing specific treatments are reimbursed for the services provided to the patients. Correct medical codes must be used to document the diagnosis, screening and other procedures performed. Medical billing and coding services provided by reputable companies can help physicians in using the correct codes for their medical billing process. The following ICD-10 codes are relevant with regard to “sarcoidosis” – D86 - Sarcoidosis 

D86.0 - Sarcoidosis of lung



D86.1 - Sarcoidosis of lymph nodes



D86.2 - Sarcoidosis of lung with sarcoidosis of lymph nodes



D86.3 - Sarcoidosis of skin

D86.8 - Sarcoidosis of other sites 

D86.81 - Sarcoid meningitis



D86.82 - Multiple cranial nerve palsies in sarcoidosis



D86.83 - Sarcoid iridocyclitis



D86.84 - Sarcoid pyelonephritis



D86.85 - Sarcoid myocarditis



D86.86 - Sarcoid arthropathy



D86.87 - Sarcoid myositis



D86.89 - Sarcoidosis of other sites

There is no known cure for sarcoidosis, but in half of the cases, it goes away on its own. Mild signs can often be effectively managed by making simple lifestyle changes. Stopping the habit of smoking and avoiding exposure to dust, chemicals, fumes and toxic gases can help prevent most cases of this disease. Following a healthy lifestyle integrated with a balanced diet, adequate exercise and sleep can help prevent the occurrence of this condition.

For clinicians, accurate medical coding of the condition is important from the point of view of care provision as well as reimbursement. So, pulmonologists treating patients with this condition can consider pulmonary medical billing service provided by an experienced provider. This will help them to code

the

condition

correctly

on

their

claims

and

ensure

optimal

reimbursement.

Isolated

Cardiac

Sarcoidosis

May

Be

Rarer

than

Previously

Suggested – Finds Study A new study suggests that isolated cardiac sarcoidosis, which refers to cardiac involvement without the disease clinically apparent, may be rarer than

previously

reported.

The

study

results

were

published

in

the

International Journal of Cardiology. Researchers evaluated the rate of isolated cardiac sarcoidosis in a group of patients by imaging the whole body with a technique called - 18F-fluorodeoxyglucose (FDG) positron emission tomography and computed tomography (PET-CT). This imaging technique that is considered a standard method tracks a radio labeled analog of glucose, a natural sugar in the body. In addition, the team measured the extent of extra-cardiac sarcoidosis at the time patients developed their first signs of cardiac symptoms.

The study included a total of 31 Caucasian patients (with a mean age of 56 years), who underwent whole-body and cardiac 18F–FDG PET-CT imaging.

As part of the study, researchers classified patients into two different groups on the basis of their sarcoidosis history. The group included– 

Group 1 – Included 20 patients – with no previous history of sarcoidosis in any organ



Group 2 – Included 11 patients – with a remote history of extracardiac sarcoidosis

The key findings of the study include 

Out of the total 31 patients analyzed, researchers found only one case of isolated cardiac sarcoidosis, with no signs of sarcoidosis anywhere else.



The other 30 patients reported no signs of this disorder in at least one other organ besides the heart. But the extent proved to be limited and included signs that were restricted to the lungs. This pattern was similar when both patient groups were compared.



Active lung involvement was observed in 45 percent of patients in the first group, or 9 patients out of 20.



On the other hand, active lung involvement was detected in about 55 percent of people or 6 patients out of 11 in the second group.



When compared to patients initially showing extra-cardiac disease, a statistically significant difference in two parameters of heart function– (right ventricular and atrial involvement) were found between patients with cardiac sarcoidosis as their first manifestation.

The study results signify that clinicians and imaging specialists should pay specific attention to these findings, and how they relate to presentation, prognosis and arrhythmias. Researchers concluded that out of the two groups analyzed, most patients depicted limited cardiac involvement at the time of presentation of manifest CS [cardiac sarcoidosis]. However, isolated CS, using the proposed gold standard, was only observed in one patient.