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ICD-10 Guide
ICD-10 CodesJ04.11

J04.11

Acute tracheitis with obstruction

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/06/2025

Code Description

ICD-10 J04.11 is a billable code used to indicate a diagnosis of acute tracheitis with obstruction.

Key Diagnostic Point:

Acute tracheitis with obstruction is an inflammatory condition of the trachea characterized by swelling and irritation, often resulting from viral infections, bacterial infections, or irritants such as smoke or chemicals. Clinically, patients may present with a harsh, dry cough, stridor, and difficulty breathing due to the narrowing of the airway. The anatomy involved includes the trachea, which is a vital airway structure connecting the larynx to the bronchi. Disease progression can vary; in mild cases, symptoms may resolve with conservative management, while severe cases can lead to significant airway obstruction, necessitating emergency intervention. Diagnostic considerations include a thorough history and physical examination, imaging studies such as X-rays or CT scans to assess for obstruction, and possibly bronchoscopy to visualize the trachea and obtain cultures if bacterial infection is suspected. Prompt diagnosis and treatment are essential to prevent complications such as respiratory failure.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires differentiation from other respiratory conditions such as croup or bronchitis.
  • Treatment complexity: May involve medications, airway management, and in severe cases, surgical intervention.
  • Documentation requirements: Detailed clinical notes are necessary to support the diagnosis and treatment plan.
  • Coding specificity: Requires accurate coding to reflect the presence of obstruction.

Audit Risk Factors

  • Common coding errors: Misclassification of the severity of tracheitis or failure to document obstruction.
  • Documentation gaps: Incomplete clinical notes that do not clearly outline the diagnosis or treatment.
  • Billing challenges: Potential denials if the documentation does not support the necessity of procedures performed.

Specialty Focus

Medical Specialties

Pulmonology

Documentation Requirements

Standard ICD-10-CM documentation requirements apply

Common Clinical Scenarios

Various clinical presentations within this specialty area

Billing Considerations

Follow specialty-specific billing guidelines

Emergency Medicine

Documentation Requirements

Standard ICD-10-CM documentation requirements apply

Common Clinical Scenarios

Various clinical presentations within this specialty area

Billing Considerations

Follow specialty-specific billing guidelines

Related CPT Codes

CPT Code

Clinical Scenario

Documentation Requirements

CPT Code

Clinical Scenario

Documentation Requirements

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

Acute tracheitis with obstruction can significantly impact patient health, leading to increased healthcare utilization due to emergency visits and potential hospital admissions. Understanding the epidemiology of this condition is crucial, as it can affect populations at higher risk, such as children and individuals with pre-existing respiratory conditions. Quality measures may include monitoring the timely diagnosis and management of airway obstruction to improve patient outcomes.

ICD-9 vs ICD-10

Acute tracheitis with obstruction can significantly impact patient health, leading to increased healthcare utilization due to emergency visits and potential hospital admissions. Understanding the epidemiology of this condition is crucial, as it can affect populations at higher risk, such as children and individuals with pre-existing respiratory conditions. Quality measures may include monitoring the timely diagnosis and management of airway obstruction to improve patient outcomes.

Reimbursement & Billing Impact

Reimbursement considerations include the severity of the condition and the complexity of care. Common denials may arise from insufficient documentation supporting the diagnosis of obstruction or the necessity of procedures performed. Best practices include ensuring that all clinical notes are comprehensive and that the medical necessity for any interventions is clearly articulated.

Resources

Clinical References

  • •
    ICD-10 Official Guidelines for J00-J99
  • •
    Clinical Documentation Requirements

Coding & Billing References

  • •
    ICD-10 Official Guidelines for J00-J99
  • •
    Clinical Documentation Requirements

Frequently Asked Questions

What specific conditions are covered by J04.11?

J04.11 specifically covers acute tracheitis with obstruction, which may arise from viral infections, bacterial infections, or environmental irritants. It is characterized by inflammation of the trachea leading to airway narrowing and respiratory distress.

When should J04.11 be used instead of related codes?

J04.11 should be used when there is clear documentation of acute tracheitis accompanied by obstruction. If obstruction is not present, J04.10 should be used instead. Accurate clinical assessment is crucial for appropriate code selection.

What documentation supports J04.11?

Documentation should include a detailed history of symptoms, physical examination findings indicating respiratory distress, and any imaging or diagnostic tests performed. Clear notes on the presence of obstruction and the treatment plan are essential.