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ICD-10 Guide
ICD-10 CodesJ98.11

J98.11

Atelectasis

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

Code Description

ICD-10 J98.11 is a billable code used to indicate a diagnosis of atelectasis.

Key Diagnostic Point:

Atelectasis refers to the partial or complete collapse of the lung or a section (lobe) of the lung, leading to reduced gas exchange and respiratory function. It can occur due to various factors, including obstruction of the airways (e.g., mucus plugs, foreign bodies), compression from outside the lung (e.g., pleural effusion, tumors), or post-surgical complications. Clinically, patients may present with symptoms such as dyspnea, cough, and decreased breath sounds on auscultation. The anatomy involved primarily includes the alveoli, bronchi, and pleura. Disease progression can vary; acute atelectasis may develop rapidly, while chronic atelectasis can lead to long-term lung dysfunction if not addressed. Diagnostic considerations include imaging studies such as chest X-rays or CT scans, which can reveal areas of lung collapse, and pulmonary function tests to assess the extent of impairment. Early identification and management are crucial to prevent complications such as pneumonia or respiratory failure.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires imaging and clinical correlation.
  • Treatment complexity: May involve bronchoscopy, chest physiotherapy, or surgical intervention.
  • Documentation requirements: Detailed clinical notes and imaging reports are necessary.
  • Coding specificity: Requires accurate identification of the cause and extent of atelectasis.

Audit Risk Factors

  • Common coding errors: Misclassification of atelectasis as pneumonia or other lung conditions.
  • Documentation gaps: Insufficient clinical details regarding the cause or treatment of atelectasis.
  • Billing challenges: Potential denials due to lack of supporting documentation or unclear coding.

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

CPT Code

Clinical Scenario

Documentation Requirements

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

Atelectasis has significant clinical implications, as it can lead to decreased lung function and increased risk of respiratory infections. In terms of population health, it is essential to monitor and manage atelectasis, particularly in high-risk groups such as post-operative patients or those with chronic lung diseases. Quality measures may include tracking the incidence of atelectasis in hospitalized patients and implementing preventive strategies to reduce its occurrence, thereby improving overall healthcare utilization and patient outcomes.

ICD-9 vs ICD-10

Atelectasis has significant clinical implications, as it can lead to decreased lung function and increased risk of respiratory infections. In terms of population health, it is essential to monitor and manage atelectasis, particularly in high-risk groups such as post-operative patients or those with chronic lung diseases. Quality measures may include tracking the incidence of atelectasis in hospitalized patients and implementing preventive strategies to reduce its occurrence, thereby improving overall healthcare utilization and patient outcomes.

Reimbursement & Billing Impact

Reimbursement considerations include the necessity of imaging studies and any therapeutic interventions performed, such as bronchoscopy or chest physiotherapy. Common denials may arise from insufficient documentation or failure to demonstrate medical necessity for the services rendered. Best practices include ensuring that all clinical notes are detailed and that the coding accurately reflects the patient's condition and treatment plan.

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 J98.11?

J98.11 specifically covers atelectasis due to various causes, including obstructive, compressive, or post-surgical factors. It does not include atelectasis due to underlying lung diseases like COPD or pneumonia, which are coded separately.

When should J98.11 be used instead of related codes?

J98.11 should be used when the primary diagnosis is atelectasis, particularly when it is the main focus of treatment or when it significantly impacts the patient's respiratory status. It should not be used when the atelectasis is secondary to another primary condition.

What documentation supports J98.11?

Documentation should include clinical findings, imaging results showing lung collapse, treatment plans, and any underlying conditions contributing to the atelectasis. Clear notes on the patient's symptoms and response to treatment are also essential.