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v1.0.0
ICD-10 Guide
ICD-10 CodesB59

B59

Pneumocystosis

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/05/2025

Code Description

ICD-10 B59 is a billable code used to indicate a diagnosis of pneumocystosis.

Key Diagnostic Point:

Pneumocystosis, also known as Pneumocystis pneumonia (PCP), is an opportunistic infection caused by the fungus Pneumocystis jirovecii, primarily affecting immunocompromised individuals, such as those with HIV/AIDS, cancer patients undergoing chemotherapy, and organ transplant recipients. The infection is characterized by a range of respiratory symptoms, including cough, fever, and difficulty breathing, which can progress to severe respiratory distress if not treated promptly. Diagnosis typically involves clinical evaluation, imaging studies such as chest X-rays or CT scans, and laboratory tests including bronchoalveolar lavage (BAL) to identify the organism. Treatment usually involves the administration of trimethoprim-sulfamethoxazole (TMP-SMX), with alternatives available for those who are intolerant or allergic. Prophylactic measures are recommended for high-risk populations to prevent the onset of the disease. Given its association with immunosuppression, pneumocystosis is a significant concern in tropical and subtropical regions where HIV prevalence is high, necessitating awareness and prompt intervention.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between Pneumocystis pneumonia and other types of pneumonia.
  • Understanding the immunocompromised status of the patient.
  • Proper documentation of clinical symptoms and diagnostic tests.
  • Knowledge of prophylactic treatment protocols.

Audit Risk Factors

  • Inadequate documentation of immunocompromised status.
  • Failure to document the specific diagnostic tests performed.
  • Misclassification of the type of pneumonia.
  • Lack of clarity in treatment protocols followed.

Specialty Focus

Medical Specialties

Infectious Disease

Documentation Requirements

Detailed patient history, laboratory results, and treatment plans.

Common Clinical Scenarios

Patients with HIV/AIDS presenting with respiratory symptoms.

Billing Considerations

Ensure documentation reflects the immunocompromised status and any prophylactic treatments administered.

Pulmonology

Documentation Requirements

Pulmonary function tests, imaging studies, and clinical assessments.

Common Clinical Scenarios

Patients with respiratory distress and a history of opportunistic infections.

Billing Considerations

Document the severity of respiratory symptoms and any co-existing lung conditions.

Coding Guidelines

Inclusion Criteria

Use B59 When
  • Follow official ICD
  • 10 coding guidelines, ensuring accurate documentation of the patient's immunocompromised status and the specific diagnostic tests performed
  • Include any relevant co
  • morbid conditions that may affect treatment

Exclusion Criteria

Do NOT use B59 When
No specific exclusions found.

Related CPT Codes

94640CPT Code

Pulmonary function test

Clinical Scenario

Used to assess lung function in patients with suspected pneumocystosis.

Documentation Requirements

Document the reason for the test and any relevant clinical findings.

Specialty Considerations

Pulmonologists should ensure comprehensive pulmonary assessments are included.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of Pneumocystis pneumonia, improving the accuracy of data collection and reimbursement processes for healthcare providers.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of Pneumocystis pneumonia, improving the accuracy of data collection and reimbursement processes for healthcare providers.

Reimbursement & Billing Impact

reimbursement processes for healthcare providers.

Resources

Clinical References

  • •
    CDC Pneumocystis Pneumonia Information

Coding & Billing References

  • •
    CDC Pneumocystis Pneumonia Information

Frequently Asked Questions

What is the primary cause of Pneumocystosis?

Pneumocystosis is primarily caused by the fungus Pneumocystis jirovecii, which is an opportunistic pathogen affecting immunocompromised individuals.