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ICD-10 Guide
ICD-10 CodesJ84.116

J84.116

Cryptogenic organizing pneumonia

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

Code Description

ICD-10 J84.116 is a billable code used to indicate a diagnosis of cryptogenic organizing pneumonia.

Key Diagnostic Point:

Cryptogenic organizing pneumonia (COP) is a form of lung inflammation characterized by the presence of granulation tissue in the alveoli and bronchioles, leading to impaired gas exchange. Clinically, patients may present with symptoms such as cough, dyspnea, and fever, which can mimic other respiratory conditions. The anatomy involved primarily includes the alveolar spaces and bronchioles, where the organizing pneumonia process occurs. Disease progression can vary; some patients may experience spontaneous resolution, while others may develop chronic symptoms or complications if left untreated. Diagnostic considerations include high-resolution computed tomography (HRCT) scans, which typically reveal patchy ground-glass opacities and consolidations. A lung biopsy may be necessary to confirm the diagnosis and rule out other conditions such as infections or malignancies. Given its idiopathic nature, the exact etiology of COP remains unclear, complicating the management and treatment approaches for affected individuals.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity
  • Treatment complexity
  • Documentation requirements
  • Coding specificity

Audit Risk Factors

  • Common coding errors include misclassification with other types of pneumonia.
  • Documentation gaps may arise if the clinical rationale for the diagnosis is not clearly stated.
  • Billing challenges can occur if the treatment plan is not adequately supported by clinical documentation.

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

Radiology

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

Cryptogenic organizing pneumonia has significant clinical implications, as it can lead to chronic respiratory issues if not diagnosed and treated promptly. The condition affects a diverse population, with varying incidence rates across demographics. Understanding its impact on population health is crucial for improving quality measures and healthcare utilization patterns, particularly in respiratory care settings. Epidemiologically, awareness of COP can enhance early detection and management strategies, ultimately improving patient outcomes.

ICD-9 vs ICD-10

Cryptogenic organizing pneumonia has significant clinical implications, as it can lead to chronic respiratory issues if not diagnosed and treated promptly. The condition affects a diverse population, with varying incidence rates across demographics. Understanding its impact on population health is crucial for improving quality measures and healthcare utilization patterns, particularly in respiratory care settings. Epidemiologically, awareness of COP can enhance early detection and management strategies, ultimately improving patient outcomes.

Reimbursement & Billing Impact

Reimbursement considerations include ensuring that the diagnosis is supported by clinical evidence and that any procedures performed, such as bronchoscopy or imaging studies, are appropriately coded. Common denials may arise from insufficient documentation or failure to provide evidence of medical necessity. Best practices include maintaining clear and comprehensive records of patient encounters, treatment rationale, and follow-up care to support claims.

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 J84.116?

J84.116 specifically covers cryptogenic organizing pneumonia, which is characterized by the presence of granulation tissue in the lungs without an identifiable cause. It is essential to differentiate it from other forms of organizing pneumonia that may have identifiable etiologies.

When should J84.116 be used instead of related codes?

J84.116 should be used when the diagnosis of cryptogenic organizing pneumonia is confirmed, and no other underlying cause can be identified. It is important to ensure that the clinical documentation supports this diagnosis and excludes other potential causes of lung inflammation.

What documentation supports J84.116?

Documentation for J84.116 should include clinical findings, imaging results (such as HRCT), and any biopsy results that confirm the diagnosis of cryptogenic organizing pneumonia. Additionally, a thorough history and physical examination should be documented to rule out other respiratory conditions.